Abstract
ObjectiveTo obtain more accurate calculations of maternal and pregnancy-related mortality ratios in Sweden from 1988 to 2007 by using information from national registers and death certificates.DesignA national register-based study, supplemented by a review of death certificates.SettingSweden, 1988–2007.PopulationThe deaths of 27 957 women of reproductive age (15–49 years).MethodsThe Swedish Cause of Death Register, Medical Birth Register, and National Patient Register were linked. All women with a diagnosis related to pregnancy in at least one of these registers within 1 year prior to death were identified. Death certificates were reviewed to ascertain maternal deaths. Maternal mortality ratio (the number of maternal deaths/100 000 live births, excluding and including suicides), and pregnancy-related mortality ratio (number of deaths within 42 days after termination of pregnancy, irrespective of cause of death/100 000 live births) were calculated.Main outcome measuresDirect and indirect maternal deaths and pregnancy-related deaths.ResultsThe maternal mortality ratio in Sweden, based on the current method of identifying maternal deaths, was 3.6. After linking registers and reviewing death certificates, we identified 64% more maternal deaths, resulting in a ratio of 6.0 (or 6.5 if suicides are included). The pregnancy-related mortality ratio was 7.3. A total of 478 women died within a year after being recorded with a diagnosis related to pregnancy.ConclusionsBy including the 123 cases of maternal death identified in this study, the mean maternal mortality ratio from 1988 to 2007 was 64% higher than reported to the World Health Organization.
Highlights
99% of maternal deaths occur in low-income countries, healthy young women still die in high-income countries due to complications of pregnancy and childbirth
We identified 491 women in the Cause of Death Register (CDR) or National Patient Register (NPR) with at least one diagnosis from the International Classification of Diseases (ICD) chapter cited earlier, or a delivery registered in the Medical Birth Register (MBR) within 1 year prior to the woman’s death
The major finding of this study is the occurrence of 64% more maternal deaths than those identified through underlying cause of death only, giving a maternal mortality ratio of 6.0 instead of 3.6, which is equivalent to the adjustment factor of 1.5 used by World Health Organization (WHO)
Summary
99% of maternal deaths occur in low-income countries, healthy young women still die in high-income countries due to complications of pregnancy and childbirth. Maternal mortality decreased in Europe until the 1980s [1,2,3] but recent data from several European countries have indicated increasing maternal mortality rates [4,5,6,7]. In part, these changes are due to improved data assessment, but demographic changes such as increased Key Message. Accurate surveillance of maternal mortality, even in countries with few cases like Sweden, requires better tools. Accurate surveillance of maternal deaths may lead to changes in patient care
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