Background:
Despite improvements in many health indicators, maternal mortality has plateaued in Bangladesh. In 2010, the ratio of cause-specific deaths due to preeclampsia/eclampsia decreased compared with 2001; however, in 2016, it stagnated. Achieving the global target of reductions in maternal mortality and the associated Sustainable Development Goals will not be possible without actions to prevent deaths due to preeclampsia/eclampsia. In this paper, we examined the levels, trends, specific causes, timing, place, and care-seeking behaviours of women who died due to these two causes.

Methods:
We used nationally representative Bangladesh Maternal Mortality and Health Care Surveys (BMMS) conducted in 2001, 2010, and 2016 to examine levels and trends of deaths due to preeclampsia/eclampsia. The analysis of specific causes, timing, and place of preeclampsia/eclampsia deaths, and care-seeking before the deaths was based on 41 such deaths captured in the 2016 survey. We used thematic content analysis of the open history from the 2016 survey verbal autopsy (VA) questionnaire to highlight stories that put faces to the numbers.

Findings:
The preeclampsia/eclampsia-specific mortality ratio decreased from 77 per 100,000 live births in the 2001 BMMS to 40 per 100,000 live births in the 2010 BMMS. The decline reached an apparent stalling in the 2016 BMMS, with preeclampsia/eclampsia-specific deaths of 46 per 100,000 live births. Although preeclampsia/eclampsia accounted for around one-fifth of all maternal deaths in the 2010 BMMS, in the 2016 BMMS, the percentage contribution reached the 2001 BMMS level of 24%. All deceased women left their homes to care-seek; however, the majority had to visit more than one facility before they died.

Conclusions:
Awareness of maternal complications, proper care seeking, and healthy reproductive practices, like family planning to space and limit pregnancy through client supportive counselling, may provide benefits. Improving regular and emergency maternal services readiness is essential.