Abstract

Like in many other high-income countries, maternal mortality has become a rare event in the Netherlands. The rarity of the event, which renders anonymization of cases increasingly difficult, combined with an increased focus on data protection, may facilitate under-reporting and hamper measurements of incidence. Moreover, differences in death classification between the Netherlands and, for instance, the United Kingdom make inter-country comparisons problematic. Is the proportion of indirect deaths versus direct deaths in the Netherlands really that much lower compared to the UK, or is it a matter of misclassification or underreporting? And how do we stay vigilant to prevent severe complications that we rarely encounter anymore in clinical practice, but which may have very severe consequences if we fail to manage them correctly?

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