Table 1 Phenotypic conditions with diagnostic criteria adapted to a low-income setting

Maternal Conditions

Chorioamnionitis

Cases where antibiotic treatment was specifically indicated for preterm premature rupture of membranes (PPROM). Suspected chorioamnionitis cases with intact membranes were not possible to identify in this data set

Stated as a diagnosis OR PPROM and presence of at least one of the following OR no PPROM and presence of at least two of the following without documented extrauterine infection: one measured maternal temperature > 38 °C, maternal tachycardia (≥ 100 beats per minute), leukocytosis (leukocytes ≥  + in urinalysis), fetal tachycardia (> 160 beats per minute), maternal bradycardia (< 60 bpm), uterine tenderness, foul-smelling and/or green amniotic fluid and/or cervical discharge

Extrauterine infection

Presence of at least 1 of the following: malaria, pyelonephritis. sexually transmitted diseases (including syphilis and HIV/AIDS), and other clinically documented infections that required use of antibiotics or other treatments during pregnancy, except when antibiotics were used for PPROM

Human immunodeficiency virus (HIV): Positive HIV test (rapid test, enzyme-link immunosorbent assay or viral culture) OR documented known HIV positive OR maternal ARV use OR neonatal nevirapine administration. General Infection: Unspecified fever > 38 °C. Malaria: Stated diagnosis OR merozoite surface protein (MSP) presence in blood panel. Syphilis: Stated diagnosis OR one reactive/positive Venereal Disease Research Laboratory (VDRL) test. Urinary Tract Infection: Stated diagnosis OR one of the following on urinalysis: leukocytes +  +  + / +  + , and/or pus cells +  +  + / +  + , and/or epithelial cells +  +  + / +  + 

Pre-eclampsia

Defined as elevated blood pressure (≥ 140/90 mm Hg), 30 mm Hg increase of systolic pressure, or 15 mm Hg increase of diastolic pressure in relation to basal measurements observed at least twice, the interval of the measurements being > 4 h but < 168 h and proteinuria > 2 + by dipstick

Stated diagnosis OR MgSO4 administration OR at least one documented blood pressure ≥ 140/90 mmHg and one or more of the following OR no documented blood pressures and two or more of the following: + protein or greater in a urinalysis, blurry vision, severe headache, lower extremities edema, oligohydramnios without PPROM

Severe maternal condition (clinically active during the index pregnancy)

Cases with a relevant clinical condition documented in the medical records in which birth was caregiver initiated because of the severity or complications related to these conditions. This excludes cases in which there was also an obstetric reason for induction/cesarean delivery. Clinical conditions associated with caregiver-initiated preterm birth included diabetes mellitus, thyroid disease, other endocrine diseases, cardiac disease, hypertension previous to pregnancy, chronic respiratory disease (including chronic asthma), renal disease, cancer, lupus erythematosus, any coagulopathy (including falciparum anemia), tuberculosis, severe intestinal malabsorption (including Crohn and celiac diseases), maternal congenital abnormality or genetic disease (e.g., cystic fibrosis or cardiac congenital defects), epilepsy, or any other clinical condition that required surgery or referral to specialized care

Presence of one or more of the following conditions: maternal anemia (Hg < 11 g/dL), diabetes mellitus, thyroid disease, other endocrine diseases, cardiac disease, hypertension previous to pregnancy, chronic respiratory disease (including chronic asthma), renal disease, cancer, lupus erythematosus, any coagulopathy (including falciparum anemia), tuberculosis, severe intestinal malabsorption (including Crohn’s and celiac diseases), maternal congenital abnormality or genetic disease (e.g. cystic fibrosis or cardiac congenital defects), epilepsy, or any other clinical condition that required surgery or referral to specialized care. Specific additions of sickle cell anemia and other documented severe anemia not related to the presence of malaria infection

HELLP Syndrome

HELLP (hemolysis, elevated liver enzymes and low platlets) or any other coagulation abnormalities reported from a pregnant woman with pre-eclampsia or eclampsia

Unable to be diagnosed in this setting

Fetal Conditions

Antepartum stillbirth

All fetal deaths occurring before the clinically reported start of labor

Documented macerated stillbirth OR diagnosis of intrauterine fetal death

Fetal anemia

For example, due to fetal hemolytic disease; Rhesus negative

Stated diagnosis OR documented maternal rhesus negative status

Fetal anomaly

Severe anomalies diagnosed through pregnancy ultrasonography or on neonatal examination

Severe anomalies documented post-partum

Fetal distress

Diagnosis based on: (1) abnormal antepartum nonstress test reported in the medical record as indication for induction of labor or elective cesarean delivery or (2) severe intrapartum electronic fetal monitoring pattern equivalent to category 3 of NICHD as indication for intrapartum cesarean delivery

Stated diagnosis OR presence of meconium OR fetal tachycardia (≥ 160 beats per minute) or fetal bradycardia (< 110 beats per minute)

Intrauterine growth restriction suspicion

Suspicion of impaired fetal growth during pregnancy based on ultrasonography examinations or physical examination and specifically stated in the medical record

Unable to be diagnosed in this setting due to questionable quality of gestational age and limited prenatal ultrasound completion

Multiple births

 ≥ 2 Fetuses in the same pregnancy

 ≥ 2 Fetuses in the same pregnancy

Fetal conditions

Early pregnancy bleeding

Vaginal bleeding < 15⁺⁰ weeks’ gestation

Unable to be diagnosed in this setting due to limited antenatal care data and few women seeking care in the first trimester

Mid-to-late pregnancy bleeding

Vaginal bleeding ≥ 15⁺⁰ weeks’ gestation without the diagnosis of pre-eclampsia, eclampsia, or HELLP syndrome

Vaginal bleeding ≥ 15 weeks’ gestation either as a documented diagnosis or as any bleeding prior to rupture of membranes OR specific diagnosis of placenta previa or placental abruption

Third trimester bleeding and pre-eclampsia

Vaginal bleeding occurring > 27⁺⁰ weeks’ gestation in women diagnosed as having severe pre-eclampsia, eclampsia, or HELLP syndrome

Pre-eclampsia or eclampsia AND antepartum bleeding, placenta previa or placental abruption

Outcomes Definitions

Pre-discharge mortality

Babies born alive but with a documented mortality before the time of discharge OR 5- or 10- minutes APGAR scores equal to 0 (resuscitation is typically unsuccessful in this setting)