Rise in maternal mortality in the Netherlands
Article first published online: 26 NOV 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 117, Issue 4, pages 399–406, March 2010
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
- Issue published online: 8 FEB 2010
- Article first published online: 26 NOV 2009
- Accepted 3 August 2009. Published Online 26 November 2009.
- Immigrant populations;
- maternal mortality;
- 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.