Open AccessMaternal mortality in Italy: Results and perspectives of record‐linkage analysis
Author(s) -
Donati Serena,
Maraschini Alice,
Lega Ilaria,
D'Aloja Paola,
Buoncristiano Marta,
Manno Valerio
Publication year - 2018
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13415
Subject(s) - medicine , pregnancy , standardized mortality ratio , record linkage , cause of death , mortality rate , maternal death , maternal mortality rate , demography , obstetrics , pediatrics , population , environmental health , disease , health services , genetics , sociology , biology
Accurate estimates and reliable classification of maternal deaths are imperative steps in the chain of actions targeted at reducing avoidable maternal mortality. The aims of this study were to estimate the maternal mortality ratio ( MMR ) in 10 Italian regions covering 77% of total national births and to identify the most suitable approach to classify the causes of death. Material and methods Deaths during and within 1 year after pregnancy have been identified through linkage between death registry and hospital discharge database. Regional and national data sources from 2006 to 2012 were used. The MMR has been estimated and deaths were classified as direct or indirect and according to their primary causes. Results A total of 277 maternal deaths within 42 days after pregnancy were identified: 149 direct, 102 indirect causes and 26 unclassified‐resulting in a MMR of 9.18 per 100 000 live births. The under‐reporting rate of official MMR figures in the participating regions is 60.3%. Hemorrhage ( MMR 1.92), hypertensive disorders of pregnancy and cardiac diseases ( MMR 1.06) were the leading causes of deaths occurring within 42 days after pregnancy, whereas malignancy (39%) and violent deaths (17%) were the most frequent of the 543 late maternal deaths. Conclusions Record‐linkage is an efficient and reliable method to estimate maternal mortality and to identify causes of maternal deaths. Both the indirect/direct and the classification by primary cause have a role in countries where direct deaths exceed indirect maternal mortality. Building upon linkage data, confidential enquiries further increase the likelihood of reducing maternal mortality.