Factors associated with maternal death from severe preeclampsia in the post- pandemic era: a cross-sectional study from Southern Morocco

Preeclampsia is a leading cause of maternal mortality worldwide. The aim of this study was to identify factors associated with maternal death due to severe preeclampsia (SPE) in Souss Massa, region of southern Morocco. A multicentric retrospective cross-sectional study was conducted in three referral hospitals from March 2020 to March 2024, based on the medical records of pregnant women with blood pressure ≥ 160/120 mmHg and proteinuria ≥ 3+. Univariate and multivariate logistic regression analyses were performed with a 95% confidence interval and a 5% significance level. A total of 295 records were initially collected. After incomplete records were excluded, 237 patients were eligible. The case fatality rate was 13.2%. The multivariate analysis revealed six variables as potential factors associated with maternal death: absence of fetal heartbeat (aOR = 55.74 [10.89–285.17]) and fetal bradycardia (aOR = 26.85 [2.12–338.78]), altered consciousness (aOR = 10.31 [2.15–49.33]), maternal age <25 years (aOR = 12.97 [1.80–93.51]) and ≥35 years (aOR = 6.01 [1.07–33.60]), rural residence (aOR = 7.72 [1.80–93.51]), severe anaemia (aOR = 13.72 [1.67–112.65]), and preexisting diabetes mellitus (aOR = 6.05 [1.01–36.30]). This study highlights the high-risk profiles of maternal death due to SPE in a Moroccan region with significant prevalence and lethality. Managing modifiable risk factors and addressing disparities in access to skilled maternal care could mitigate the adverse outcomes of preeclampsia. Future research should adopt a prospective, longitudinal design, focusing on sociocultural context specific to the region.