TY - JOUR
T1 - Maternal mortality in Italy
T2 - Results and perspectives of record-linkage analysis
AU - The Regional Maternal Mortality Working Group
AU - Donati, Serena
AU - Maraschini, Alice
AU - Lega, Ilaria
AU - D'Aloja, Paola
AU - Buoncristiano, Marta
AU - Manno, Valerio
AU - Alberico, Salvatore
AU - Antonelli, Antonello
AU - Asole, Simona
AU - Basevi, Vittorio
AU - Cetin, Irene
AU - Chiodini, Paolo
AU - Dardanoni, Gabriella
AU - Di Lallo, Domenico
AU - Dubini, Valeria
AU - Germinario, Cinzia
AU - Giangreco, Manuela
AU - Gnaulati, Lisa
AU - Loverro, Giuseppe
AU - Lupi, Camilla
AU - Martinelli, Pasquale
AU - Mazzone, Arianna
AU - Merlino, Luca
AU - Meloni, Alessandra
AU - Monasta, Lorenzo
AU - Mondo, Luisa
AU - Parisi, Davide
AU - Pezzella, Marcello
AU - Polo, Arianna
AU - Puglia, Monia
AU - Rusciani, Raffaella
AU - Schimmenti, Immacolata
AU - Sozzi, Pierluigi
AU - Spettoli, Daniela
AU - Voller, Fabio
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Introduction: 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.
AB - Introduction: 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.
KW - eclampsia
KW - high-risk pregnancy
KW - mortality
KW - postpartum depression
KW - postpartum hemorrhage
KW - preeclampsia
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85050464653&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050464653&partnerID=8YFLogxK
U2 - 10.1111/aogs.13415
DO - 10.1111/aogs.13415
M3 - Article
C2 - 29956300
AN - SCOPUS:85050464653
VL - 97
SP - 1317
EP - 1324
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
SN - 0001-6349
IS - 11
ER -