Maternal mortality in Sweden 1988–2007: more deaths than officially reported. (4th December 2012)

• Record Type: Journal Article
• Authors: Esscher, Annika; Högberg, Ulf; Haglund, Bengt; Essën, Birgitta
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 92:Number 1(2013)
• Page Start: 40
• Page End: 46
• Publication Date: 2012-12-04
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12037
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12037-abs-0001"> <title>Abstract</title> <sec id="aogs12037-sec-0001" sec-type="section"> <title>Objective</title> <p>To 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.</p> </sec> <sec id="aogs12037-sec-0002" sec-type="section"> <title>Design</title> <p>A national register‐based study, supplemented by a review of death certificates.</p> </sec> <sec id="aogs12037-sec-0003" sec-type="section"> <title>Setting</title> <p>Sweden, 1988–2007.</p> </sec> <sec id="aogs12037-sec-0004" sec-type="section"> <title>Population</title> <p>The deaths of 27 957 women of reproductive age (15–49 years).</p> </sec> <sec id="aogs12037-sec-0005" sec-type="section"> <title>Methods</title> <p>The 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.</p> </sec> <sec id="aogs12037-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Direct and indirect maternal deaths and pregnancy‐related deaths.</p> </sec> <sec id="aogs12037-sec-0007" sec-type="section"> <title>Results</title> <p>The 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.</p> </sec> <sec id="aogs12037-sec-0008" sec-type="section"> <title>Conclusions</title> <p>By 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.</p> </sec> </abstract>