Underreporting of Pregnancy-Related Mortality in the United States and Europe

Deneux‐Tharaux, Catherine; Berg, Cynthia J.; Bouvier‐Colle, Marie‐Hélène; Gissler, Mika; Harper, Margaret; Nannini, Angela; Alexander, Sophie; Wildman, Katherine; Breart, Gérard; Buekens, Pierre

doi:10.1097/01.aog.0000174580.24281.e6

Cited by 165 publications

(117 citation statements)

References 22 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…Classification by cause of death in vital statistics, however, can be imprecise for rare causes of deaths in the industrialised countries. 20,21 Inversely, the data on which our study is based come from recent detailed national studies: the information about the controls is detailed on the characteristics of the women, the pregnancy and the delivery. For the cases, the information is very specific about management (e.g.…”

Section: Discussionmentioning

confidence: 99%

Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care?

Philibert

Deneux‐Tharaux

Bouvier‐Colle

2008

BJOG

View full text Add to dashboard Cite

Objectives To test the hypothesis that the risk of postpartum maternal death in France remains significantly higher for women of foreign nationality after individual characteristics are taken into account and to examine whether the quality of care received by the women who died differs according to nationality.Design A national case-control study. Setting Metropolitan France.Population A total of 267 women who died of maternal death from 1996 to 2001 as cases and a representative sample (n = 13 186) of women who gave birth in 1998 as controls.Methods Crude and adjusted odd ratios were calculated with multivariate logistic regression, and the quality of care for cases was compared according to nationality with chi-square tests or Fisher's exact tests.Main outcome measures Odd ratio for postpartum maternal death associated with nationality and quality of care.Results After taking individual characteristics into account, the risk of postpartum maternal death was twice as high for foreign women. The odds ratio was 5.5 (95% CI: 3.3-9.0) for women from sub-Saharan Africa and 3.3 (95% CI: 1.7-6.5) for those from Asia, North and South America. There was no significant excess risk of postpartum maternal death for the other European and North Africa women. The risk of dying from hypertensive disorder or infection was four times higher for foreign women. Among women who died, care was more often considered not optimal for foreign women (78 versus 57%).Conclusions The excess risk of postpartum maternal death persisted for foreign women after individual characteristics were taken into account and was especially important for some nationalities and for some causes of death, primarily hypertensive disorders. These results point to an immediate need to pay special attention to early enrolment in prenatal care, screening and prenatal management of hypertension, especially in women of sub-Saharan African nationality.Keywords Maternal mortality, nationality, quality of care.Please cite this paper as: Philibert M, Deneux-Tharaux C, Bouvier-Colle M. Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care?

show abstract

Section: Discussionmentioning

confidence: 99%

Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care?

Philibert

Deneux‐Tharaux

Bouvier‐Colle

2008

BJOG

View full text Add to dashboard Cite

show abstract

“…Compared to most developed countries and their cities, São Paulo City has a much higher MMR 8 with an underreporting rate of 52.2%, which is within the range observed in Europe and in the United States. 9 Hypertensive disorders in pregnancy, delivery, and puerperium represented the main cause of maternal death in São Paulo City, resulting in 23.3% of deaths. In contrast, arterial hypertension occupies third place (15.9%) after thromboembolism (19.9%) and hemorrhage (18.2%) in the United States.…”

Section: Discussionmentioning

confidence: 99%

Maternal Mortality Due to Arterial Hypertension in São Paulo City (1995-1999)

Vega

Kahhale

Zugaib

2007

Clinics

View full text Add to dashboard Cite

AIM:To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. METHODS:The Committee on Maternal Mortality of São Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2% and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3%) cases. RESULTS: Ninety-five (66.9%) of the deaths occurred during the puerperal period and 34 (23.9%) occurred during pregnancy. The time of death was not reported in 13 (9.2%) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4%), acute pulmonary edema (24.6%), and coagulopathies (14.1%). Cesarean section was performed in 85 (59.9%) cases and vaginal delivery in 15 (16.0%). CONCLUSION: Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in São Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.

show abstract

“…The most recent report of the CEMD (for 2006-2008) identified 60% more maternal deaths than were reported in the routine civil registration system (12). Other studies on the accuracy of the number of maternal deaths reported in civil registration systems have shown that the true number of maternal deaths could be twice as high as indicated by routine reports, or even more (13,14). Appendix 1 summarizes the results of a literature review for such studies where misclassification on coding in civil registration could be identified.…”

Section: Approaches For Measuring Maternal Mortalitymentioning

confidence: 99%

“…Maternal mortality data available from countries varied in terms of the source and type, and countries were classified accordingly into three groups (Table 1, and Appendices 2-4). In total, the database of observed MMR and PM includes 3200 countryyears of data, of which 2125 country-years are derived from vital registration data, 895 from survey-based sisterhood data, and the remainder from surveillance systems (87), other household surveys (31), censuses (19), RAMOS (16), sample registration systems (14) and other sources (13). Observation intervals refer to 1985 or later.…”

Section: Sources Of Country Data Used For the 1990-2010 Estimatesmentioning

confidence: 99%