Maternal mortality in S weden 1988–2007: more deaths than officially reported

Objective To obtain more accurate calculations of maternal and pregnancy‐related mortality ratios in S weden from 1988 to 2007 by using information from national registers and death certificates. Design A national register‐based study, supplemented by a review of death certificates. Setting S weden, 1988–2007. Population The deaths of 27 957 women of reproductive age (15–49 years). Methods The S wedish C ause of D eath R egister, M edical B irth R egister, and N ational P atient R egister were linked. All women with a diagnosis related to pregnancy in at least one of these registers within 1 year prior to death were identified. Death certificates were reviewed to ascertain maternal deaths. Maternal mortality ratio (the number of maternal deaths/100 000 live births, excluding and including suicides), and pregnancy‐related mortality ratio (number of deaths within 42 days after termination of pregnancy, irrespective of cause of death/100 000 live births) were calculated. Main outcome measures Direct and indirect maternal deaths and pregnancy‐related deaths. Results The maternal mortality ratio in S weden, based on the current method of identifying maternal deaths, was 3.6. After linking registers and reviewing death certificates, we identified 64% more maternal deaths, resulting in a ratio of 6.0 (or 6.5 if suicides are included). The pregnancy‐related mortality ratio was 7.3. A total of 478 women died within a year after being recorded with a diagnosis related to pregnancy. Conclusions By including the 123 cases of maternal death identified in this study, the mean maternal mortality ratio from 1988 to 2007 was 64% higher than reported to the W orld H ealth O rganization.