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Maternal mortality as an indicator of obstetric care in Europe
Author(s) -
Wildman Katherine,
BouvierColle MarieHélène
Publication year - 2004
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1046/j.1471-0528.2003.00034.x-i1
Subject(s) - medicine , context (archaeology) , cause of death , pregnancy , maternal death , standardized mortality ratio , obstetric transition , demography , infant mortality , mortality rate , pediatrics , population , environmental health , maternal health , disease , health services , sociology , biology , pathology , paleontology , genetics
Objective This analysis considers the usefulness of maternal mortality ratio (MMR) as an indicator of obstetric care in the context of low overall maternal mortality. We explore whether variation in the level of MMR among European countries reflects differences in obstetric care. Design The data presented in this article were collected as part of the European Concerted Action on Mothers' Mortality and Severe morbidity (MOMS). In this study, a panel of experts followed a protocol to determine cause of death and whether it was pregnancy‐related. This analysis uses the expert panel's confirmation of cause of death and obstetric attribution. Setting All maternal deaths within 11 European countries. Population Two hundred and ninety obstetric deaths occuring between 1992 and 1995. Methods We present the results of a multivariable analysis that controls for cause of death, moment of death, place of death, pregnancy outcome, women's age and nationality. Main outcome measures We test the hypothesis that countries with higher MMR would have proportionally more cases of direct obstetric death due to thromboembolism, hypertension, haemorrhage or infection compared with other countries in the study. We examine timing of death and maternal age to measure whether there are differences between country groups for older mothers. Results We find distinct patterns in cause and timing of death and age‐specific mortality ratios between countries with different levels of MMR. Conclusions Despite low rates of maternal mortality in Europe, between‐country differences follow patterns with respect to cause and timing of death and maternal age. In addition to representing an important indicator of health status in a country, differences in MMR among European countries provide insight to where obstetric care plays a role maternal deaths.