Table 1.
Summary of characteristics and findings of the included studies (ordered chronologically)
| Ref. Langu. |
Sample, setting, time, design, analysis | Main Findings | Quality score (0–22) |
|---|---|---|---|
| Farzianpour et al. 2017 [35]. English |
N = 109 Tehran Province 2011–2015 XS (descriptive) |
Descriptive: Residence (rural 38%, urban 56%, unknown = 6%), Education (primary 20%, high school 30%, university 50%), Occupation (employed 71%, unemployed 29%), Main insurance (social security 50%, public health service 34%, private 16%), Supplemental insurance (yes 27%, no 73%), Economic status (high 25%, middle 10%, poor 65%), Time of death (pregnancy 25%, delivery 9%, post-delivery 66%), Place of death (home 2%, in transportation 5%, health facility 93%) Most frequent cause: Hypertension (23.6%) |
18 |
| Shahidi et al. 2017 [36]. Farsi |
N = 20 Sabzevar city 2003–2013 XS (bivariate) χ2 test |
Descriptive: Mean age 31, Mean gravity 2.6, Residence (Urban 70%, rural 30%), Type of delivery (ND 40%, CS = 60%) Most frequent cause: Hemorrhage (30%), Underling disease (30%) Determinants: Associated [Residence, p = 0.04] |
18 |
| Jamshidi et al. 2016 [37]. English |
N = 70 Khuzestan Province 2009–2013 XS (descriptive) |
Descriptive: Mean gravity 2.9, Mean parity 1.7, Residence (urban 54.3%, rural 45.7%), Occupation (employed 6%, unemployed 94%), Education (illiterate 13%, primary 66%, high school 13%, university 9%), Attended pregnancy (wanted 84%, unwanted 11%, unknown 5%) Most frequent cause: Hemorrhage (31.4%) |
17 |
| Karimzaei et al. 2016 [24]. English |
N = 34 Iranshahr city2009–2013 XS (bivariate) χ2 test |
Descriptive: Mean age 30, Mean gravity 3.9, Type of delivery (ND 50%, CS 18%, undelivered 32%), Residence (rural 65%, urban 35%), Education (illiterate 47%, primary 29%, high school 15%, university 9%), Place of birth (hospital 50%, home 9%, labor facility 9, undelivered 32%), Birth attendant (skilled 53%, trained 3%, traditional 6%, undelivered 32%), Economic status (high 38%, middle 29%, poor 32%) Most frequent cause: Hemorrhage (38.2%) Determinants: Associated [Gravidity, (p = 0.005)], NOT associated [Residence, type of birth, birth attendant, mother’s age and place of birth] |
19 |
| Vahiddastjerdy M et al. 2016 [12]. English |
N = 896 Iran 2009–2012 XS (descriptive) |
Descriptive: Mean age 30, Type of delivery (ND 26%, CS 44%, others 30%), Time of death (during pregnancy/childbirth 26%, postpartum 74%), Education (illiterate 18%, primary 72%, university 10%, no response 6%), Place of birth (hospital 67%, home 3%, on the way 2%, no response 28%), Economic status (high 1%, middle 3%, poor 90%, unknown 5%), Occupation (unemployed 91%, employee 9%) Most frequent cause: Hemorrhage (24.2%) |
17 |
| Kamiabi et al. 2015 [38]. Farsi |
N = 1805 Iran 2007–2012 Ecological study (multivariate) Regression |
Descriptive: Type of delivery (ND 29%, CS 61%), Education (illiterate 24%, literate 76%), Place of birth (health facility 93%, & home and way 7.2%), Birth attendant (skilled and trained 94%, traditional 6%), Prenatal care (yes 94%, No 6.3%), Completed prenatal care (Yes 66%, No 34%) Determinants: Associated [Completed prenatal care, Type of delivery, Education, Birth place, Birth attendant, Prenatal care, Improved water source], NOT associated [Male literacy, Use of improved sanitation, Attendance of girls in secondary schools] |
19 |
| Karimi-Zarchi et al. 2015 [39]. English |
N = 40 Yazd province 2002–2011 XS (descriptive) |
Descriptive: Mean age 29, Mean gravidity 2.6, Type of delivery (ND 20%, CS 55% & others 25%), Education (under diploma 40% & diploma or higher 60%), Place of death (hospital 92.5% & home 7.5%), Birth attendant (General practitioner 82.5%, trained midwife 12.5% & Local Midwife/Untrained Midwife 5%), Prenatal care (yes 77.5%, & No 22.5%) Most frequent cause: Hemorrhage (30%) |
15 |
| Tirkesh et al. 2015 [40]. Farsi |
N = 22 Dezful 2007–2012 XS (bivariate) χ2 & ANOVA tests |
Descriptive: Mean age 28, Period of death (during pregnancy 50% & postpartum 50%), Residence (rural/nomads 68% & urban 32%), Place of death (hospital 92% & home 18%) Most frequent cause: Underling disease (40.9%) Determinants: Associated [maternal age (p = 0.02)], NOT Associated [residence, type of delivery, place of maternal death and period of death] |
16 |
| Gholampour H. 2015 [41]. Farsi |
Iran 2008–2013 Panel study χ2 test |
Determinants: Associated [Fertility rate(p = 0.00), family income(p = 0.006), population(p = 0.004)], NOT Associated [Urbanization, hospital beds, number of midwifes & number of physician] | 18 |
| Rajai et al. 2014 [42]. Farsi |
N = 91 Hormozgan province 2005–2012 XS (bivariate) χ2 & ANOVA |
Descriptive: Mean age 30, Mean gravidity 3.8, Type of delivery (ND 43%, CS 37% & others 20%), Period of death (during pregnancy 23% & postpartum 77%), Residence (rural/nomads 60% & urban 40%) Most frequent cause: Hemorrhage (38.2%) Determinants: Associated [Type of deliveries (p = 0.001), risk factors during pregnancy (p = 0.022) & gravidity (p = 0.025)], NOT Associated [Residence, mother’s age and place of death] |
17 |
| Zokaei et al. 2014 [43]. Farsi |
N = 79 Kurdistan province 2001–2013 XS (descriptive) |
Descriptive: Mean age 35, Type of delivery (ND 37%, CS 52% & undelivered 11%), Period of death (during pregnancy 99% & unknown1%), Residence (rural/nomads 52% & urban 48%), Education (illiterate 66%, Under diploma29% & diploma and higher 5%), Place of birth (hospital 90%, home 8%, labor facility1% & in the way 1%), Pregnancy intentions (wanted 71%, unwanted19% & unknown10%) Occupation (housewife 98.7%, & employee 1.3%) Most frequent cause: Hemorrhage (34.2%) |
17 |
| Farrokh-Eslamlou et al.2014 [44]. English |
N = 183 West Azerbaijan Province 2002–2011 XS (descriptive) |
Descriptive: Type of delivery (ND 42%, CS 34% & others 24%), Period of death (during pregnancy 24% & postpartum 76%), Place of death (hospital 56%, in the way/home 20% & unknown24%), Pregnancy intentions (wanted 61% & unwanted39%), Prenatal care: (yes 80%, & No 20%) Most frequent cause: Hemorrhage (29.6%) |
18 |
| Poorolajal et al. 2014 [45]. English |
N = 185 Hamadan Province 2006–2014 case-control study Regression |
Descriptive: Mean age 30, Type of delivery (ND 32%, CS 49% & others 19%), Residence (rural/nomads 43% & urban 57%), Place of death (hospital 86%, home 5%, in the way 3% & unknown 5%), Birth attendant (Specialist 49%, midwife 30% & undelivered21%) Most frequent cause: Hemorrhage (37.1%) Determinants: Associated [Maternal age (p = 0.049), gravidity (p = 0.02) and preterm (< 37) of gestational age (p = 0.001) overweight (p = .01)], NOT Associated [Type of delivery and birth attendant, underweight] |
18 |
| Jamshid Pour et al. 2014 [46]. Farsi |
N = 99 Kermanshah Province 2001–2013 XS (bivariate) χ2 test andregression |
Descriptive: Mean age 31, Mean gravidity 3.4, Type of delivery (ND 42%, CS 45% & Others 12%), Period of death (during pregnancy 18%, childbirth 3% & postpartum 79%), Residence (rural/nomads 33% & urban 67%), Pregnancy intentions (wanted 36%, unwanted 30% & unknown 33%) Most frequent cause: Hemorrhage (23.2%) Determinants: Associated [period of death, & residence (p = 0.008)], NOT Associated [maternal age, pregnancy care, & mothers at highly risk] |
17 |
| Mobasheri et al. 2014 [47]. Farsi |
N = 28 Chaharmahal Bakhtaran Province 2002–2012 XS (descriptive) |
Descriptive: Mean age 31, Type of delivery (ND 32%, CS 46% & others 21%), Period of death (during pregnancy14% & postpartum 86%), Residence (rural/nomads 71% & urban 29%), Education (illiterate 50%, primary level21.4, diploma 14.3%, university level14.3%) Most frequent cause: Hemorrhage (32.1%) |
17 |
| Zarean et al. 2014 [27]. Farsi |
N = 67 Esfahan province 2006–2012 XS (descriptive) |
Descriptive: Period of death (during pregnancy 30% & postpartum 70%) Most frequent cause: Hemorrhage (22.4%) |
15 |
| Heidari et al. 2014 [48]. Farsi |
N = 84 Kerman province 2006–2012 XS (bivariate) Poisson regression |
Descriptive: Type of delivery (ND 45% & CS 55%), Period of death (during pregnancy 21% & postpartum 79%), Residence (rural/nomads 60% & urban 40%), Place of death (hospital 88% & in the way/home 12%), Place of birth (hospital 83% & in the way/home 17%), Birth attendant (General practitioner 64%, trained/untrained midwife 13% & Midwife 23%) Most frequent cause: Eclampsia (21.4%) Determinants: Associated [type of delivery (p = 0.01), midwife as a birth attendant (p = 0.006), trained and untrained midwifes (p < 0.001), & place of birth (p = 0.04)], NOT Associated [residence, maternal age, place of death, & period of death] |
16 |
| Sarani et al. 2014 [49]. Farsi |
N = 57 Sistan and Baluchestan province 2002–2014 XS (descriptive) |
Descriptive: Mean age 33.5, Mean gravidity 3.8, Type of delivery (ND 49% & CS 51%), Period of death (during pregnancy 26% & postpartum 74%), Residence (rural/nomads 96% & urban 4%), Education (illiterate 16% & literate 84%) Most frequent cause: Embolism (19.2%) |
15 |
| Mohammadinia et al. 2013 [50]. Farsi |
N = 307 Sistan and Baluchestan province 2002–2010 XS (bivariate) χ2 & ANOVA |
Descriptive: Mean age 28, Mean gravidity 4.1, Type of delivery (ND 61% & CS 39%), Period of death (during pregnancy 21% & postpartum 79%), Residence (rural/nomads 71% & urban 29%), Education (illiterate 62% & literate 38%), Place of death (hospital 59%, home 16%, labor facility 9% & in the way 16%), Birth attendant (Specialist/General Practitioner/Midwife 47%, trained midwife 10%, Local Midwife/Untrained Midwife 21% & undelivered21%) Most frequent cause: Hemorrhage (39.5%) Determinants: Associated [type of birth (p = 0.03), birth attendant (p = 0.005) and place of maternal death (p < 0.001)], NOT Associated [Residence] |
18 |
| Zolala F et al. .2012 [51]. English |
Iran 2001–2008 Ecological study multivariate analysis |
Determinants: Associated [male literacy (p < 0.001), unemployment (p = 0.04), & female literacy (p = 0.02)], NOT Associated [Proportion of midwives, & Urban residency] | 17 |
| Maharlouei et al. 2012 [52]. English |
N = 101 Fars province 2003–2010 XS (descriptive) |
Descriptive: Mean age 30, Type of delivery (ND 36%, CS 61% & others3%), Period of death (during pregnancy 24%, childbirth5% & postpartum 71%), Residence (rural/nomads 50% & urban 50%), Place of death (hospital 82%, home 6% & in the way 12%), Pregnancy intentions (wanted 76%, unwanted17% & unknown7%) Most frequent cause: Hemorrhage (35.6%) |
17 |
| Tajik P et al. 2011 [53]. English |
Iran 2004–2006 Ecological study Regression |
Determinants: Associated [Human development index (p < 0.001),&difference in illiteracy rate in women and men(p = 0.03)], NOT Associated [Gini coefficient] | 20 |
| Abdollahipour et al. 2011 [54]. Farsi |
N = 25 Ilam Province 2001–2011 XS (bivariate) Fisher, T, χ2 tests, regression |
Descriptive: Period of death (during pregnancy/childbirth 20% & postpartum 80%), Residence (rural/nomads 48% & urban 52%) Most frequent cause: Hemorrhage (36%) Determinants: Associated [education, underling disease (p = 0.001), high risk pregnancy, gravidity and quality of care (p = 0.001)] |
17 |
| GholamiTaramsari et al. 2008 [55]. Farsi |
N = 66 Kohkiluyeh and Boyerahmad Province 1997–2007 XS (bivariate) χ2 test |
Descriptive: Mean age 29, Type of delivery (ND 59%, CS32% & others 9%), Period of death (during pregnancy 9%, childbirth 26% & postpartum 65%), Residence (rural/nomads 77%, urban 23%), Education (illiterate 82% & literate 18%) Most frequent cause: Hemorrhage (41%) Determinants: Associated [education (p < 0.001), residence (p < 0.001), type of delivery (p < 0.001), place of maternal death (p < 0.001) and period of death (p < 0.001)], NOT Associated [gravidity] |
17 |
| Farrokh-Eslamlou et al. 2006 [56]. Farsi |
N = 96 West Azerbaijan province 2001–2005 XS (bivariate) Regression |
Descriptive: Mean age 31, Period of death (during pregnancy 25%, childbirth 49%, postpartum 17% & unknown 9%), Residence (rural/nomads 25%, urban 66% & unknown 9%), Education (illiterate 71%, literate 20% & unknown9%), Place of birth (hospital 49%, home/in the way 51%) Most frequent cause: Hemorrhage (46%) Determinants: Associated [education (p = 0.001), maternal age (p < 0.01), gravidity (p = 0.001), immune pregnancy ratio (p < 0.01)] |
18 |
| Mansouri et al. 2005 [28]. Farsi |
N = 17 Khorasan province 1999–2005 XS (descriptive) |
Descriptive: Mean age 31, Mean gravidity 3.1 Most frequent cause: Embolism (35.3%) |
15 |
| Galyan Tehrani et al. 2004 [57]. Farsi |
N = 55 Kurdistan province 1998–2003 XS (bivariate) χ2 test |
Descriptive: Type of delivery (ND 44%, CS 31% & others25%), Residence (rural/nomads 65% & urban 35%), Education (illiterate 44%, literate 40% & unknown16%), Place of birth (hospital 44%, home 29%, in the way 2% & undelivered25%), Birth attendant (General Practitioner 31%, trained midwife 4%, untrained midwife 25%, Midwife 15% & undelivered25%), Occupation (housewife 91.7%, & employee 8.3%), Prenatal care (yes 65.5%, & No 34.5%) Most frequent cause: Hypertension (31.8%) & abortion (31.8%) Determinants: Associated [type of delivery (p = 0.0006), gravidity (p = 0.003), birth attendant (p = 0.0000), & pregnancy care (p = 0.0000)], NOT Associated [maternal age, place of birth, type of job, and education] |
17 |
| Mehrzad-Sadagiani et al. 2003 [58]. English |
N = 66 West Azerbaijan Province 1995–1998 XS (descriptive) |
Descriptive: Type of delivery (ND 71%, CS 12% & others 17%), Residence (rural/nomads 12% & urban 88%), Education (illiterate 97% & literate 3%), Birth attendant (Specialist 3%, General Practitioner 3%, trained midwife 42%, Midwife 9% & undelivered 42%) Most frequent cause: Hemorrhage (54.6%) |
15 |
| Akhlagi et al. 2003 [59]. Farsi |
N = 31 Mashhad Province 1991–2001 XS (descriptive) |
Most frequent cause: Hemorrhage (58%) | 15 |
XS Cross sectional, ND Normal delivery, CS Cesarean section