Volume 29, Issue 2 (5-2026)
J Arak Uni Med Sci 2026, 29(2): 107-118 |
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Mohammadi A, Motamedi M, Soleimanvandi N, Baradaran H, Abedini M, Eshrati B et al . Exploratory Study of the Root Causes of Deaths of Pregnant Mothers with COVID-19 Registered in Affiliated Units of Iran University of Medical Sciences. J Arak Uni Med Sci 2026; 29 (2) :107-118
URL: http://jams.arakmu.ac.ir/article-1-8102-en.html
URL: http://jams.arakmu.ac.ir/article-1-8102-en.html
Alireza Mohammadi1 
, Mahnaz Motamedi2 , Neda Soleimanvandi3 , Hamidreza Baradaran4 , Mehrirandokht Abedini5 , Babak Eshrati6 , Zahra Kianfar7
, Mahnaz Motamedi2 , Neda Soleimanvandi3 , Hamidreza Baradaran4 , Mehrirandokht Abedini5 , Babak Eshrati6 , Zahra Kianfar7
1- Department of Disease Prevention and Control, Deputy of Health, Arak University of Medical Sciences, Arak, Iran
2- Department of AIDS and STD Control, Center for Communicable Disease Management, Ministry of Health and Medical Education, Tehran, Iran
3- Department of Social and Family Medicine, Faculty of Medicine, Preventive Medicine and Population Health Research Center, Institute for the Prevention of Social Disorders, Iran University of Medical Sciences, Tehran, Iran
4- Department of MPH, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
5- Deputy of Treatment, Ministry of Health and Medical Education, Tehran, Iran
6- Department of Social and Family Medicine, Faculty of Medicine, Preventive Medicine and Population Health Research Center, Institute for the Prevention of Social Disorders, Iran University of Medical Sciences, Tehran, Iran ,h.ak58@yahoo.com
7- Department of Obstetrics, Imam Ali (AS) Hospital, Komijan, Arak University of Medical Sciences, Arak, Iran
2- Department of AIDS and STD Control, Center for Communicable Disease Management, Ministry of Health and Medical Education, Tehran, Iran
3- Department of Social and Family Medicine, Faculty of Medicine, Preventive Medicine and Population Health Research Center, Institute for the Prevention of Social Disorders, Iran University of Medical Sciences, Tehran, Iran
4- Department of MPH, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
5- Deputy of Treatment, Ministry of Health and Medical Education, Tehran, Iran
6- Department of Social and Family Medicine, Faculty of Medicine, Preventive Medicine and Population Health Research Center, Institute for the Prevention of Social Disorders, Iran University of Medical Sciences, Tehran, Iran ,
7- Department of Obstetrics, Imam Ali (AS) Hospital, Komijan, Arak University of Medical Sciences, Arak, Iran
Abstract: (326 Views)
Introduction: COVID-19 presents a spectrum of symptoms, from mild cases to systemic pneumonia. Since the onset of the pandemic, 141,000 people have died in Iran. Pregnant women are vulnerable due to physiological changes and relative immunosuppression. Maternal mortality is an indicator of a country's developmental status, yet the root causes of COVID-19-related maternal deaths in Iran have not been investigated. This study aimed to identify underlying factors.
Methods: This was an exploratory mixed-methods study. In the qualitative phase, written death scenarios and focus group discussions were employed. Using content analysis and root cause analysis techniques, preventable factors were identified and a causal network was mapped. Conditional probabilities for each contributing factor were determined. Subsequently, a Bayesian belief network was constructed using Netica software, and sensitivity analysis was applied to quantify the contribution of each factor and prioritize them.
Results: Among 38 reviewed deaths, 68.4% were attributed to COVID-19 as the primary cause. Qualitative analysis revealed multiple systemic failures, including delays in treatment, diagnosis, and referral; untimely presentation; inadequate prenatal care; non-adherence to protocols; poor teamwork; and equipment shortages. After quantification, these factors collectively accounted for 54.7% of maternal deaths. Sensitivity analysis identified lack of awareness/non-adherence to protocols (40%) and treatment delays (100%) as the most important root causes.
Conclusions: Maternal deaths among COVID-19-positive women are largely driven by structural and managerial gaps within the healthcare system and are therefore preventable through system-oriented interventions. Clinical management alone is insufficient; reducing mortality—both during pandemics and in normal times—requires addressing root causes such as strengthening referral systems, targeted education, effective team-based care, and active monitoring of high-risk pregnancies.
Methods: This was an exploratory mixed-methods study. In the qualitative phase, written death scenarios and focus group discussions were employed. Using content analysis and root cause analysis techniques, preventable factors were identified and a causal network was mapped. Conditional probabilities for each contributing factor were determined. Subsequently, a Bayesian belief network was constructed using Netica software, and sensitivity analysis was applied to quantify the contribution of each factor and prioritize them.
Results: Among 38 reviewed deaths, 68.4% were attributed to COVID-19 as the primary cause. Qualitative analysis revealed multiple systemic failures, including delays in treatment, diagnosis, and referral; untimely presentation; inadequate prenatal care; non-adherence to protocols; poor teamwork; and equipment shortages. After quantification, these factors collectively accounted for 54.7% of maternal deaths. Sensitivity analysis identified lack of awareness/non-adherence to protocols (40%) and treatment delays (100%) as the most important root causes.
Conclusions: Maternal deaths among COVID-19-positive women are largely driven by structural and managerial gaps within the healthcare system and are therefore preventable through system-oriented interventions. Clinical management alone is insufficient; reducing mortality—both during pandemics and in normal times—requires addressing root causes such as strengthening referral systems, targeted education, effective team-based care, and active monitoring of high-risk pregnancies.
Keywords: Covid-19, Pregnant Woman, Content analysis, Maternal Mortalit, Bayesian Belief Network, Root Case Analysis.
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