Confidential enquiry into maternal deaths in The Netherlands 1983–1992

doi:10.1016/S0301-2115(98)00053-0

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 79, Issue 1, 1 July 1998, Pages 57-62

https://doi.org/10.1016/S0301-2115(98)00053-0 Get rights and content

Abstract

Objective: To determine the causes of maternal death in The Netherlands. Study design: Nationwide Confidential Enquiry into the Causes of Maternal Deaths during the period 1983–1992. Results: Of 192 direct and indirect maternal deaths, 154 (80%) were available for the Enquiry. The most frequent direct causes were (pre-)eclampsia, thrombo-embolism, obstetrical haemorrhage and sepsis. Cerebro- and cardiovascular disorders were the most frequent indirect causes of death. Age above 35 years and parity 3 or more are related to higher maternal mortality. Women from non-caucasian origin are more prone to death in comparison to caucasian women. Autopsy was performed in 88 cases (57%). Of the 24 women where labour started at home, the place of birth played a significant role in delay in four. Conclusions: More efforts should be made to have a higher percentage than 80% available for the Confidential Enquiry as in the UK where only 1–4% of deaths are not available for similar purposes. Also, the autopsy rate of 57% is much lower than in the UK (82%). Special strategies should be developed to improve maternal health of populations at higher risk such as women of high age and parity and immigrant populations.

Introduction

The only previous nationwide confidential enquiry into maternal deaths in The Netherlands concerned the years 1966 and 1967 [1]. The available data since then are derived from national vital statistics. These are limited and without further details such data are insufficient for the conduction of a confidential enquiry. These data are also relatively unreliable due to under-reporting and misclassification [2].

The Dutch Society of Obstetrics and Gynaecology (DSOG) established a Maternal Mortality Committee (MMC) in 1981 in order to achieve a more reliable classification of underlying causes, and to investigate whether further improvement is possible. The MMC initiated a nationwide confidential enquiry into maternal deaths involving the 10 year period from 1983 up to 1992.

Section snippets

Materials and methods

All deaths related with pregnancy in The Netherlands between 1983 and 1992 were included in the study. Maternal death was defined according to the World Health Organization's (WHO) International Classification of Diseases, ninth revision (ICD-9). Maternal mortality cases were voluntarily reported to the MMC by obstetricians and in some cases by midwives and general practitioners. Additional cases were collected after a cross-check with Central Bureau of Statistics (CBS), Dutch Perinatal

Results

In the study period, 237 maternal deaths were identified. Of these, 144 cases were classified as direct maternal death, and 113 (79%) were available for the confidential enquiry. Of the 48 indirect maternal deaths, 41 (85%) could be included in the enquiry.

The most frequent direct causes of maternal death were (pre-)eclampsia, thrombo-embolism, obstetrical haemorrhage and genital tract sepsis (Table 1). Of these, 78/93 (84%) were available for the confidential enquiry.

Cerebrovascular

Discussion

Of the 192 direct and indirect maternal deaths, 154 (80%) could be included in the study. In the Confidential Enquiries in the UK (Report 1994), however, only 14/339 (4%) and in the latest report 3/323 (1%) were not made available for the Enquiry (Report 1996) 5, 6.

Lack of acquaintance with the confidential enquiry in The Netherlands may explain the difference in cooperation, though a call to report cases to the MMC is made regulary at DSOG meetings. The UK Confidential Enquiries into the

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The MMR from direct maternal mortality from AFLP was 0.13 per 100,000 live births (95% CI 0.05–0.29). The incidence of severe maternal morbidity from AFLP was 3.2 per 100,000 deliveries (95% CI 1.8–5.7).
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