LEMBAR CRITICAL APPRAISAL

BERDASARKAN PICO-VIA

Judul artikel :
Factors associated with maternal mortality at advanced maternal age : a population-based case-
control study
Nama jurnal :
BJOG An International Journal of Obstetrics and Gynaecology

P (POPULATION or PATIENT or PROBLEM)

Population : pregnant women aged 35 years
Sample : cases of maternal deaths aged 35 years between 2009-2012 from
MBRRACE-UK database
Control : cases of pregnant women aged 35 years or older from UKOSS data
base between 2005 and 2012.
Problem : The maternal mortality ratio (MMR) increases non-linearly with age

I ( INTERVENTION or INDICATOR or INDEX TEST or exposure of INTEREST )

Group I : cases of maternal deaths aged 35 years between 2009-2012 from MBRRACE-UK
database

C ( COMPARISON )
Group II : group control 766 cases of pregnant women aged 35 years or older from UKOSS
data base between 2005 and 2012.

O ( OUTCOME of interest )
1. The risk factors associated with maternal mortality in women of advanced maternal
age
2. The association between maternal mortality and smoking among women aged 35 years
or older
3. Medical comorbidities were an important risk factor for maternal mortality among
women of advanced maternal aged

VALID
The subject were representative ( The use of national data allowed a valid comparison
between the cases and the controls, as they were drawn from the same population. )
The study design was moderate quality ( case control study )
 Confounding factors were calculated ( age, marital status, ethnic, social economic group,
BMI, smoking status, substance misuse, previous medical history, pregnancy-related
characteristic)
There was no blinding

IMPORTANT
There are ve factors to be associated significantly with increased likelihood of maternal
mortality among women aged 35 years or older with p value < 0,05.
Exploratory analysis examining medical co-morbidities highlighted that cardiac disease,
essential hypertension, infection, musculoskeletal disorders, asthma, mental health
disorders, inflamatory disorders and neurological disorders were all independently
associated with maternal mortality in women of advanced maternal age

APPLICABLE
It can be applied but needs larger number of cases to obtain more definite result
It needs double blinded methods to obtain more unbiased result
It can be applied in Indonesia but needs further study in Indonesia

Conclusion critical appraisal

Level of evidence : III
Recommendation :C