Table 3.
Cause specific maternal mortality* (numbers, proportion of all maternal deaths, and maternal mortality ratios) in countries with enhanced surveillance systems (Denmark, Finland, France, and Italy)
| Cause of death | Denmark (10/297 835)† | Finland (22/301 169)† | France (196/2 435 583)† | Italy (112/1 281 986)† | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No (%) | MMR‡ | No (%) | MMR‡ | No (%) | MMR‡ | No (%) | MMR‡ | ||||
| Abortive outcomes§ | 0 | - (0.0 to1.2) | 3 (13.6) | 1.0 (0.24to3.2) | 7 (3.6) | 0.3 (0.1 to 0.5) | 15 (13.4) | 1.2 (0.6 to 1.9) | |||
| Obstetric haemorrhage¶ | 0 | - (0.0 to 1.2) | 2 (9.2) | 0.7 (0.1 to 2.4) | 21 (10.7) | 0.9 (0.5 to 1.3) | 16 (14.3) | 1.2 (0.7 to 2.0) | |||
| Pregnancy related infection | 1 (10.0) | 0.3 (0.0 to1.9) | 0 | - (0.0 to 1.2) | 11 (5.6) | 0.5 (0.2 to 0.8) | 6 (5.4) | 0.5 (0.1 to 1.0) | |||
| Hypertensive disorders of pregnancy** | 0 | - (0.0 to 1.2) | 1 (4.5) | 0.3 (0.01 to 1.9) | 4 (2.0) | 0.2 (0.0 to 0.4) | 11 (9.8) | 0.9 (0.4 to 1.5) | |||
| Venous thrombosis and thromboembolism | 0 | - (0.0 to 1.2) | 2 (9.2) | 0.7 (0.1 to 2.4) | 19 (9.7) | 0.8 (0.5 to 1.2) | 5 (4.5) | 0.4 (0.1 to 0.9) | |||
| Amniotic fluid embolism | 1 (10.0) | 0.3 (0.0 to 1.9) | 3 (13.6) | 1.0 (0.24 to 3.2) | 28 (14.3) | 1.1 (0.7 to 1.7) | 7 (6.3) | 0.5 (0.2 to 1.1) | |||
| Anaesthesia complication | 0 | - (0.0 to 1.2) | 1 (4.5) | 0.3 (0.01 to 1.9) | 3 (1.5) | 0.1 (0.0 to 0.3) | 1 (0.9) | 0.1 (0.0 to 0.4) | |||
| Other direct causes | 1 (10.0) | 0.3 (0.0 to 1.9) | 0 | - (0.0 to 1.2) | 6 (3.1) | 0.2 (0.0 to 0.5) | 1 (0.9) | 0.1 (0.0 to 0.4) | |||
| Cardiovascular†† | 2 (20.0) | 0.7 (0.1 to 2.4) | 1 (4.5) | 0.3 (0.01 to 1.9) | 30 (15.3) | 1.2 (0.8 to 1.7) | 15 (13.4) | 1.2 (0.6 to 1.9) | |||
| Stroke (arterial), haemorrhagic or ischaemic | 1 (10.0) | 0.3 (0.0 to 1.9) | 0 | - (0.0 to 1.2) | 11 (5.6) | 0.5 (0.2 to 0.8) | 6 (5.4) | 0.5 (0.2 to 1.0) | |||
| Indirect sepsis‡‡ | 0 | - (0.0 to 1.2) | 1 (4.5) | 0.3 (0.01 to 1.9) | 8 (4.1) | 0.3 (0.1 to 0.6) | 9 (8.0) | 0.7 (0.3 to 1.3) | |||
| Malignancy§§ | 1 (10.0) | 0.3 (0.0 to 1.9) | 0 | - (0.0 to 1.2) | 5 (2.6) | 0.2 (0.0 to 0.4) | 6 (5.4) | 0.5 (0.1 to 1.0) | |||
| Other indirect causes | 0 | - (0.0 to 1.2) | 0 | - (0.0 to 1.2) | 4 (2.0) | 0.2 (0.0 to 0.4) | 3 (2.7) | 0.2 (0.0 to 0.7) | |||
| Suicide | 3 (30.0) | 1.0 (0.2 to 2.9) | 8 (36.4) | 2.7 (1.2 to 5.2) | 8 (4.1) | 0.3 (0.1 to 0.6) | 4 (3.6) | 0.3 (0.0 to 0.8) | |||
| Illicit drug or alcohol misuse | 0 | - (0.0 to 1.2) | 0 | - (0.0 to 1.2) | 1 (0.5) | 0.0 (0.0 to 0.2) | 0 | - (0.0 to 0.3) | |||
| Unascertained | 0 | - (0.0 to 1.2) | 0 | - (0.0 to 1.2) | 30 (15.3) | 1.2 (0.8 to 1.7) | 7 (6.3) | 0.5 (0.2 to1.1) | |||
Maternal mortality up to 42 days after end of pregnancy.
Total number of maternal deaths/number of live births.
Maternal mortality ratios per 100 000 live births (95% confidence interval or one sided 97.5% confidence interval).
Ectopic pregnancy, post-abortion (spontaneous, elective, and medically indicated) haemorrhage, post-abortion infection, post-abortion pulmonary embolism, and other abortive outcomes.
Haemorrhage by uterine atony, morbidly adherent placenta, placenta praevia, uterine rupture, placenta abruption, and other obstetric haemorrhage.
Pre-eclampsia, eclampsia, and HELLP syndrome.
Peripartum cardiomyopathy, ischaemic cardiomyopathy, other cardiomyopathy, other cardiac, aortic dissection, and arterial rupture.
Influenza, pneumonia, meningitis, urinary sepsis, and other indirect sepsis.
In all countries, deaths after trophoblastic tumours were considered maternal. For other tumours, definitions of maternal death varied between countries. In Denmark, only pregnancy associated deaths (PADs) from breast cancers were considered maternal. In Finland, no formal rules were used to classify PAD as maternal, and cases were discussed individually. In France, maternal deaths were PADs from all hormone sensitive cancers or any other type of cancer for which pregnancy delayed diagnosis or treatment. In Italy, all PADs from cancers of breast, ovary, cervix, skin, blood, or brain were considered maternal.