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Rise in maternal mortality in the Netherlands

  1. JM Schutte1,
  2. EAP Steegers2,
  3. NWE Schuitemaker3,
  4. JG Santema4,†,
  5. K de Boer5,
  6. M Pel6,
  7. G Vermeulen7,
  8. W Visser2,
  9. J van Roosmalen8,9,
  10. the Netherlands Maternal Mortality Committee

Article first published online: 26 NOV 2009

DOI: 10.1111/j.1471-0528.2009.02382.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 117, Issue 4, pages 399–406, March 2010

Additional Information

How to Cite

Schutte, J., Steegers, E., Schuitemaker, N., Santema, J., de Boer, K., Pel, M., Vermeulen, G., Visser, W., van Roosmalen, J. and the Netherlands Maternal Mortality Committee (2010), Rise in maternal mortality in the Netherlands. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 399–406. doi: 10.1111/j.1471-0528.2009.02382.x

Author Information

  1. 1

    Department of Obstetrics and Gynaecology, Isala Klinieken Zwolle, Zwolle, the Netherlands

  2. 2

    Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands

  3. 3

    Diakonessenhuis Utrecht, Utrecht, the Netherlands

  4. 4

    Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Leeuwarden, the Netherlands

  5. 5

    Department of Obstetrics and Gynaecology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands

  6. 6

    Department of Obstetrics and Gynaecology, Amsterdam Medical Center, Amsterdam, the Netherlands

  7. 7

    Department of Obstetrics and Gynaecology, Diaconessenhuis Meppel, the Netherlands

  8. 8

    Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands

  9. 9

    Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands

  1. †

    Deceased.

*Dr JM Schutte, Department of Obstetrics and Gynaecology, Isala Klinieken Zwolle, Dr Van Heesweg 2, PO Box 10400, 8025 AB Zwolle, the Netherlands. Email jokeschutte@yahoo.nl

Publication History

  1. Issue published online: 8 FEB 2010
  2. Article first published online: 26 NOV 2009
  3. Accepted 3 August 2009. Published Online 26 November 2009.

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Keywords:

  • Immigrant populations;
  • maternal mortality;
  • pre-eclampsia;
  • safe motherhood;
  • substandard care

Please cite this paper as: Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, Vermeulen G, Visser W, van Roosmalen J, the Netherlands Maternal Mortality Committee. Rise in maternal mortality in the Netherlands. BJOG 2009;117:399–406.

Objective  To assess causes, trends and substandard care factors in maternal mortality in the Netherlands.

Design  Confidential enquiry into the causes of maternal mortality.

Setting  Nationwide in the Netherlands.

Population  2,557,208 live births.

Methods  Data analysis of all maternal deaths in the period 1993–2005.

Main outcome measures  Maternal mortality.

Results  The overall maternal mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the maternal mortality ratio of 9.7 in the period 1983–1992 (OR 1.2, 95% CI 1.0–1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4–4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%).

Conclusions  Maternal mortality in the Netherlands has increased since 1983–1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve maternal health care.

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