Maternal mortality in Italy: Results and perspectives of record‐linkage analysis. (20th July 2018)

• Record Type: Journal Article
• Authors: Donati, Serena; Maraschini, Alice; Lega, Ilaria; D'Aloja, Paola; Buoncristiano, Marta; Manno, Valerio
• Other Names: Alberico Salvatore investigator.; Antonelli Antonello investigator.; Asole Simona investigator.; Basevi Vittorio investigator.; Cetin Irene investigator.; Chiodini Paolo investigator.; Dardanoni Gabriella investigator.; Di Lallo Domenico investigator.; Dubini Valeria investigator.; Germinario Cinzia investigator.; Giangreco Manuela investigator.; Gnaulati Lisa investigator.; Loverro Giuseppe investigator.; Lupi Camilla investigator.; Martinelli Pasquale investigator.; Mazzone Arianna investigator.; Merlino Luca investigator.; Meloni Alessandra investigator.; Monasta Lorenzo investigator.; Mondo Luisa investigator.; Parisi Davide investigator.; Pezzella Marcello investigator.; Polo Arianna investigator.; Puglia Monia investigator.; Rusciani Raffaella investigator.; Schimmenti Immacolata investigator.; Sozzi Pierluigi investigator.; Spettoli Daniela investigator.; Voller Fabio investigator.
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 97:Number 11(2018)
• Page Start: 1317
• Page End: 1324
• Publication Date: 2018-07-20
• Subjects: eclampsia -- high‐risk pregnancy -- mortality -- postpartum depression -- postpartum hemorrhage -- preeclampsia -- pregnancy; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13415
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: Introduction: Accurate estimates and reliable classification of maternal deaths are imperative steps in the chain of actions targeted at reducing avoidable maternal mortality. The aims of this study were to estimate the maternal mortality ratio (MMR) in 10 Italian regions covering 77% of total national births and to identify the most suitable approach to classify the causes of death. Material and methods: Deaths during and within 1 year after pregnancy have been identified through linkage between death registry and hospital discharge database. Regional and national data sources from 2006 to 2012 were used. The MMR has been estimated and deaths were classified as direct or indirect and according to their primary causes. Results: A total of 277 maternal deaths within 42 days after pregnancy were identified: 149 direct, 102 indirect causes and 26 unclassified‐resulting in a MMR of 9.18 per 100 000 live births. The under‐reporting rate of official MMR figures in the participating regions is 60.3%. Hemorrhage (MMR 1.92), hypertensive disorders of pregnancy and cardiac diseases (MMR 1.06) were the leading causes of deaths occurring within 42 days after pregnancy, whereas malignancy (39%) and violent deaths (17%) were the most frequent of the 543 late maternal deaths. Conclusions: Record‐linkage is an efficient and reliable method to estimate maternal mortality and to identify causes of maternal deaths. Both the indirect/direct and the classification by primary cause have a role in countries where direct deaths exceed indirect maternal mortality. Building upon linkage data, confidential enquiries further increase the likelihood of reducing maternal mortality.