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Peer-reviewedCC BYJournal of global health

Ectopic pregnancy-related severe maternal morbidity in Shenzhen: a sentinel indicator for gaps in early pregnancy care systems.

  • Yu Dai1,2
  • Qiaoxuan Wu1
  • Litong Zhu1
  • Weichun Yang1
  • Ping Jin1
  • Shuyan Jin1
  • Fuying Tian1
  • Xiaotian Li1,3,4,5
5 affiliations
  1. 1Department of Obstetrics and Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Women and Children's Medical Center, Southern Medical University, Shenzhen, China.
  2. 2Shenzhen School of Clinical Medicine, Southern Medical University, Shenzhen, China.
  3. 3Shenzhen Clinical Research Center for Obstetrics & Gynecology and Reproductive System Diseases, Shenzhen, China.
  4. 4Shenzhen Key Laboratory of Maternal and Child Health and Diseases, Shenzhen, China.
  5. 5The Obstetrics &Gynecology Hospital Fudan University, Shanghai, China.
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Abstract

Background

Despite China's progress in reducing maternal mortality, severe maternal morbidity in early pregnancy, particularly ectopic pregnancy, remains a critical challenge in urban settings like Shenzhen. This study examines the clinical presentation scenarios, types, and sociodemographic compositions of ectopic pregnancy -related severe maternal morbidity to map potential structural vulnerabilities within the maternal healthcare continuum and propose interventions aligned with China's 'Healthy Motherhood 2030' agenda.Methods

A retrospective analysis used 2023 data from Shenzhen's Maternal and Child Health Care Management Information System, covering 66 maternity hospitals. A total of 245 ectopic pregnancy-related severe maternal morbidity cases were identified using standard WHO near-miss criteria. Statistical analyses evaluated the descriptive distributions and baseline profiles of clinical outcomes across different initial resuscitation settings.Results

Among 154,000 live births, 1,075 severe maternal morbidity cases (0.70%) included 257 (23.9%) ectopic pregnancy-related emergencies. After exclusions, we analysed 245 cases: 67.35% multiparous women, 31.84% had a junior high education or lower and 95% without prenatal care. Ectopic pregnancy-severe maternal morbidity occurred mostly at home (46.12%), followed by outpatient/emergency (30.20%) and inpatient (23.67%) settings. Among home/emergency presentations, 83.3% of women had lower education and 80.4% were employed. Tubal isthmus pregnancies (42.45%) dominated home-based emergencies, while atypical sites were frequent in clinical settings. Advanced severe complications occurred in only seven cases, limiting meaningful statistical comparisons across settings.Conclusions

In a high-resource, low-MMR urban environment, ectopic pregnancy-related emergencies account for nearly one-quarter of the total SMM burden, with acute crises often concentrated in pre-hospital or frontline care settings. These descriptive patterns suggest that maternal safety strategies should consider shifting focus toward enhancing community health literacy and rapid-response integration at the primary care level. Forward-looking interventions - such as mobile health platforms, clinical simulation training, and formalised early pregnancy emergency networks - warrant prospective evaluation as potential operational pathways to bridge the identified gaps.

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Cite

BibTeXRIS
BibTeX
@article{dai2026ectopic,
  title = {{Ectopic pregnancy-related severe maternal morbidity in Shenzhen: a sentinel indicator for gaps in early pregnancy care systems.}},
  author = {Yu Dai and Qiaoxuan Wu and Litong Zhu and Weichun Yang and Ping Jin and Shuyan Jin and Fuying Tian and Xiaotian Li},
  journal = {Journal of global health},
  year = {2026},
  month = oct,
  doi = {10.7189/jogh.16.04331},
  url = {https://europepmc.org/article/MED/42853021},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Ectopic pregnancy-related severe maternal morbidity in Shenzhen: a sentinel indicator for gaps in early pregnancy care systems.
AU  - Yu Dai
AU  - Qiaoxuan Wu
AU  - Litong Zhu
AU  - Weichun Yang
AU  - Ping Jin
AU  - Shuyan Jin
AU  - Fuying Tian
AU  - Xiaotian Li
PY  - 2026
DA  - 2026/10/09
JO  - Journal of global health
DO  - 10.7189/jogh.16.04331
UR  - https://europepmc.org/article/MED/42853021
AB  - Background  Despite China's progress in reducing maternal mortality, severe maternal morbidity in early pregnancy, particularly ectopic pregnancy, remains a critical challenge in urban settings like Shenzhen. This study examines the clinical presentation scenarios, types, and sociodemographic compositions of ectopic pregnancy -related severe maternal morbidity to map potential structural vulnerabilities within the maternal healthcare continuum and propose interventions aligned with China's 'Healthy Motherhood 2030' agenda.Methods  A retrospective analysis used 2023 data from Shenzhen's Maternal and Child Health Care Management Information System, covering 66 maternity hospitals. A total of 245 ectopic pregnancy-related severe maternal morbidity cases were identified using standard WHO near-miss criteria. Statistical analyses evaluated the descriptive distributions and baseline profiles of clinical outcomes across different initial resuscitation settings.Results  Among 154,000 live births, 1,075 severe maternal morbidity cases (0.70%) included 257 (23.9%) ectopic pregnancy-related emergencies. After exclusions, we analysed 245 cases: 67.35% multiparous women, 31.84% had a junior high education or lower and 95% without prenatal care. Ectopic pregnancy-severe maternal morbidity occurred mostly at home (46.12%), followed by outpatient/emergency (30.20%) and inpatient (23.67%) settings. Among home/emergency presentations, 83.3% of women had lower education and 80.4% were employed. Tubal isthmus pregnancies (42.45%) dominated home-based emergencies, while atypical sites were frequent in clinical settings. Advanced severe complications occurred in only seven cases, limiting meaningful statistical comparisons across settings.Conclusions  In a high-resource, low-MMR urban environment, ectopic pregnancy-related emergencies account for nearly one-quarter of the total SMM burden, with acute crises often concentrated in pre-hospital or frontline care settings. These descriptive patterns suggest that maternal safety strategies should consider shifting focus toward enhancing community health literacy and rapid-response integration at the primary care level. Forward-looking interventions - such as mobile health platforms, clinical simulation training, and formalised early pregnancy emergency networks - warrant prospective evaluation as potential operational pathways to bridge the identified gaps.
SN  - 2047-2978
SN  - 2047-2986
ER  -