Lill T Nyfløt1,2, Marianne Johansen3, Ajlana Mulic-Lutvica4, Mika Gissler5,6, Birgit Bødker7, Katarina Bremme8, Liv Ellingsen9, Siri Vangen1,10. 1. Norwegian Research center for Women's Health, Oslo University Hospital, Oslo, Norway. 2. Department of Obstetrics, Drammen Hospital, Drammen, Norway. 3. Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark. 4. Institution for Women's and Children's Health, Department for Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden. 5. Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland. 6. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden. 7. Nordsjaellands Hospital, Hillerød, Denmark. 8. Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. 9. Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway. 10. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
INTRODUCTION: Cardiovascular diseases have become increasingly important as a cause of maternal death in the Nordic countries. This is likely to be associated with a rising incidence of pregnant women with congenital and acquired cardiac diseases. Through audits, we aim to prevent future maternal deaths by identifying causes of death and suboptimal factors in the clinical management. MATERIAL AND METHODS: Maternal deaths in the Nordic countries from 2005 to 2017 were identified through linked registers. The national audit groups performed case assessments based on hospital records, classified the cause of death, and evaluated the standards of clinical care provided. Key messages were prepared to improve treatment. RESULTS: We identified 227 maternal deaths, giving a maternal mortality rate of 5.98 deaths per 100 000 live births. The most common cause of death was cardiovascular disease (n = 36 deaths). Aortic dissection/rupture, myocardial disease, and ischemic heart disease were the most common diagnoses. In nearly 60% of the cases, the disease was not recognized before death. In more than half of the deaths, substandard care was identified (59%). In 11 deaths (31%), improvements to care that may have made a difference to the outcome were identified. CONCLUSIONS: Between 2005 and 2017, cardiovascular diseases were the most common causes of maternal deaths in the Nordic countries. There appears to be a clear potential for a further reduction in these maternal deaths. Increased awareness of cardiac symptoms in pregnant women seems warranted.
INTRODUCTION:Cardiovascular diseases have become increasingly important as a cause of maternal death in the Nordic countries. This is likely to be associated with a rising incidence of pregnant women with congenital and acquired cardiac diseases. Through audits, we aim to prevent future maternal deaths by identifying causes of death and suboptimal factors in the clinical management. MATERIAL AND METHODS: Maternal deaths in the Nordic countries from 2005 to 2017 were identified through linked registers. The national audit groups performed case assessments based on hospital records, classified the cause of death, and evaluated the standards of clinical care provided. Key messages were prepared to improve treatment. RESULTS: We identified 227 maternal deaths, giving a maternal mortality rate of 5.98 deaths per 100 000 live births. The most common cause of death was cardiovascular disease (n = 36 deaths). Aortic dissection/rupture, myocardial disease, and ischemic heart disease were the most common diagnoses. In nearly 60% of the cases, the disease was not recognized before death. In more than half of the deaths, substandard care was identified (59%). In 11 deaths (31%), improvements to care that may have made a difference to the outcome were identified. CONCLUSIONS: Between 2005 and 2017, cardiovascular diseases were the most common causes of maternal deaths in the Nordic countries. There appears to be a clear potential for a further reduction in these maternal deaths. Increased awareness of cardiac symptoms in pregnant women seems warranted.