ORGANIZATIONAL DETERMINANTS OF MATERNAL AND PERINATAL MORTALITY IN UZBEKISTAN (2020–2024): A PROCESS-BASED ANALYSIS OF OBSTETRIC CARE

Background: Maternal and perinatal mortality reflect not only clinical severity but also how obstetric care processes are organized—early recognition of complications, risk-appropriate routing, timeliness of intervention, and availability of escalation mechanisms. Objective: To analyze maternal and perinatal mortality in Uzbekistan (2020–2024) through an organizational management lens, focusing on facility level at complication onset, transfers, time-to-care intervals, and use of escalation mechanisms. Methods: An analytical review was conducted using official national statistics (2020–2024) and structured expert review forms for fatal cases. Key organizational indicators included facility level (I–III), transfer patterns, admission-to-intervention time, complication-to-qualified-care time, use of sanitary aviation and multidisciplinary consilium, and expert assessment of preventability. Results: Maternal mortality showed year-to-year variability without a stable downward trend. In 69.9% of maternal death cases, the fatal event occurred outside Level III facilities. Transfers between facilities were documented in 57.4% of cases. Median admission-to-start-of-care time was 47 minutes (IQR 32–75), and median complication-to-qualified-care time was 4.8 hours (IQR 2.6–7.9). Indications for sanitary aviation were present in 31.5% of cases, while actual use was 14.2%. Expert review suggested that 75.4% of maternal deaths were potentially preventable. Perinatal mortality remained high in absolute numbers, with marked regional heterogeneity in 2024. Conclusions: A large proportion of adverse outcomes are driven by modifiable organizational factors—routing to an appropriate level of care, timeliness, and system readiness. Strengthening risk stratification, referral criteria, escalation pathways, staffing and simulation training may reduce preventable maternal and perinatal deaths.

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