Abstract
ObjectiveCardiovascular disorders are the leading cause of indirect maternal mortality in Europe. The aim of this study is to present an extensive overview concerning the specific cardiovascular causes of maternal death and to identify avoidable contributing care factors related to these deaths.MethodsWe assessed all cases of maternal death due to cardiovascular disorders collected by a systematic national confidential enquiry of maternal deaths published by the Dutch Maternal Mortality and Morbidity Committee on behalf of the Netherlands Society of Obstetrics and Gynaecology over a 21-year period (1993–2013) in the Netherlands.ResultsThere were 96 maternal cardiovascular deaths (maternal mortality rate due to cardiovascular diseases 2.4/100,000 liveborn children). Causes were aortic dissection (n = 20, 21%), ischaemic heart disease (n = 17, 18%), cardiomyopathies (including peripartum cardiomyopathy and myocarditis, n = 20, 21%) and (unexplained) sudden death (n = 27, 28%). Fifty-five percent of the deaths occurred postpartum (n = 55, 55%). Care factors that may have contributed to the adverse outcome were identified in 27 cases (28%). These factors were patient-related in 40% (pregnancy against medical advice, underestimation of symptoms) and healthcare-provider-related in 60% (symptoms not recognised, delay in diagnosis, delay in referral).ConclusionThe maternal cardiovascular mortality ratio is low in the Netherlands and the main causes of maternal cardiovascular mortality are in line with other European reports. In a minority of cases, care factors that were possibly preventable were identified. Women with cardiovascular disease should be properly counselled about the risks of pregnancy and the symptoms of complications. Education of care providers regarding the incidence, presentation and diagnosis of cardiovascular disease during pregnancy is recommended.
Highlights
Cardiovascular disorders (CVD) are the leading cause of indirect maternal mortality in European countries, including the Netherlands [1,2,3,4]
This results in a maternal mortality ratio (MMR) from cardiovascular diseases of
When evaluating maternal mortality per liveborn neonate, maternal death occurred more frequently in women with a Dutch-Antillean (MMR 11.25) or Surinamese (MMR 5.92) ethnicity compared to Dutch (MMR 2.17), Moroccan (MMR 0.75) or Turkish (MMR 2.59) ethnicity
Summary
Cardiovascular disorders (CVD) are the leading cause of indirect maternal mortality (mortality not due to direct obstetric causes) in European countries, including the Netherlands [1,2,3,4]. An increase in direct maternal mortality was observed, which includes (unexplained) sudden deaths. An ongoing national systematic confidential enquiry into maternal deaths is being performed in the Netherlands by the Dutch Maternal Mortality and Morbidity Committee (MMMC) on behalf of the Netherlands Society of Obstetrics and Gynaecology. The enquiry assesses the prevalence and causes of maternal deaths and identifies contributing care factors that may be related to the adverse outcome, with the aim of further reducing mortality and morbidity in the Netherlands. On behalf of the MMMC, the aim of our study is to present an extensive overview concerning the specific cardiovascular causes of maternal death and to identify factors related to the rise in maternal cardiovascular mortality in the Netherlands over a 21-year period [2, 3].
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