European Journal of Obstetrics & Gynecology and Reproductive Biology
Confidential enquiry into maternal deaths in The Netherlands 1983–1992
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.
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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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