Eur J Obstet Gynecol Reprod Biol. Psychiatric disorders, followed by suicide, have been identified in the UK as an emerging cause of maternal deaths [14]. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. World Health Organization. Ann Intern Med. This works out at around 1.26 million maternal deaths [140 million / [900 / 100,000] = 1.26 million]. In all preeclampsia cases, there was no information available on risk factors (e.g., history of preeclampsia) and, hence, aspirin received as prophylaxis. This is likely owing to improved clinical care, as well as to the fact that a large proportion of the additionally analysed deaths were non-pregnancy-related maternal deaths. A New Method for Deriving Global Estimates of Maternal Mortality Wilmot JR et al., Statistics, Politics and Policy, 2012, 3(2): 1-38; Related information. Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Knight MNM, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ, eds. Lebendgeburten nach Alter der Mutter 2018. Although the mode of delivery was unknown in 42 cases, more than two thirds of those cases were non-pregnancy-related deaths. 12.10.2020 For the rates of amniotic fluid embolism, a reduction from the first to the second study period (0.74/100,000 to 0.64/100,000 live births) was observed, but no further decline in the amniotic fluid embolism rate since 2004 was observed [3, 4]. doi:. When reporting the death of a female aged 15–49 years, it is mandatory to mention in the death certificate whether the woman was pregnant at the time of her death or if she had given birth on any of the previous 42 days leading up to her death. An important subgroup of maternal mortality after caesarean section are the deaths associated with the caesarean section, allowing calculation of the lethality of the caesarean section. Definitions and data sources The maternal mortality rate in the west has dropped drastically in the last 100 years. When contacting the clinics in question, we usually could not obtain much more information, which would have helped us categorise these cases, thus forcing us to exclude seven cases. Neonatal mortality rate is the number of neonates dying before reaching 28 days of age, per 1,000 live births in a given year. Curr Opin Obstet Gynecol. http://dx.doi.org/10.1097/AOG.0000000000000869 PubMed. To analyse the influence of maternal age on the mortality ratio four groups were formed: <25 years, 25–29 years, 30–34 years and ≥35 years. Maternal mortality ratio of Switzerland fell gradually from 7 deaths per 100,000 live births in 1998 to 5 deaths per 100,000 live births in 2017. It therefore omits the risk of being pregnant (i.e., fertility, in a population, which is measured by the maternal mortality rate or the lifetime risk) (Graham and Airey, 1987). SMW is an international peer-reviewed medical journal, established in 1871. Although maternal mortality due to thromboembolism has steadily decreased in the last 30 years in Switzerland, it is still an important cause of maternal deaths and thus risk assessment for venous thromboembolism is vital [14]. One woman had surgery for an ectopic pregnancy and received heparin postoperatively. We have provided a few examples below that you can copy and paste to your site: Your image export is now complete. Core Indicators of the Health and Care of Pregnant Women and Babies in Europe in 2015. Together with amniotic fluid embolism, preeclampsia/HELLP was found to be the second leading cause of maternal mortality in Switzerland, each accounting for almost 20% of all direct obstetric deaths (0.64/100,000 live births). Although overall mortality has reduced in the last 30 years, the number of women dying as a result of haemorrhage still accounts for roughly 35% of all direct maternal deaths (table 4). 2020;150:w20345. In 42 cases, the mode of delivery was not known. and 90% (OR 0.09, p<0.05, 95% CI 0.02–0.42), respectively [3, 4]. An autopsy was available for 25% of all registered cases (26 out of 102). The Swiss Society of Gynaecology and Obstetrics (SGGG) notes that in most situations action taken was too little and too late, with an unfavourable outcome [17]. on behalf of MBRRACE-UK. Immediate action is needed in a bid to meet the Sustainable Development Goals (SDG) target to reduce the global maternal mortality ratio to less than 70/100,000 live births by 2030 [2]. Trends in Maternal Mortality… This questionnaire covered personal anamnesis, family history, operations, prior pregnancies and deliveries, puerperium, mode of delivery, course of the pregnancy, fetal complications, and any available autopsy results. The indirect MMR was 3.68/100,000 live births. Available from: www.europeristat.com. Suizid nach Alter und Geschlecht (ohne assistierten Suizid) - 1995-2016 | Diagramm. Ninety-six cases were eligible for detailed evaluation. According to the MBRRACE-UK report, obstetricians need to pay special attention to women who are at risk for abnormal placentation and plan accordingly for their delivery to further reduce the rate of maternal deaths due to haemorrhage [19]. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. It has decreased by 20.5% compared with the MMR in 1995–2004 (4.15/100,000 live births, 32 cases; p = n.s.) On the first postoperative day she complained of shortness of breath and her general state deteriorated. A total of 41 non-pregnancy related deaths were analysed. : maternal mortality, Switzerland, direct mortality, indirect mortality, non-pregnancy-related mortality. Pedersen GS, Grøntved A, Mortensen LH, Andersen AM, Rich-Edwards J. Maternal mortality among migrants in Western Europe: a meta-analysis. doi:. As nationality was unknown in the majority of the analysed cases, it was not evaluated in this study. November 2018. In this study, maternal death due to thromboembolism was the third most common cause of death (0.38/100,000 live births). This study should also raise awareness of the need for precise documentation of all maternal deaths in a reasonable time-window after the woman has passed away. 2014;18(7):1628–38. In the UK, the incidence of heart disease during pregnancy has remained constant at about 0.9%, but the rate of maternal deaths due to cardiac disease has increased progressively in the last 20 years , accounting for a maternal mortality ratio of 2.18 per 100,000 maternities from 2012 to 2014 . The maternal mortality ratio is the most widely used measure of maternal deaths. The indirect MMR was 3.68/100,000 live births. 20 Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Am J Obstet Gynecol. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births [poster]. Lancet. Obstet Gynecol. Therefore, cases where death occurred within 365 days after delivery were included. Therefore, cases where death occurred within 365 days after delivery were included as well. Lifetime risk of maternal death (1 in: rate varies by country) The value for Lifetime risk of maternal death (1 in: rate varies by country) in Switzerland was 13,900 as of 2017. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. Periodic analysis of maternal deaths is not only an important tool for quality assurance in obstetrics, but is also necessary to improve clinical care. Article in German. In the general Swiss population from 2012 to 2016, the suicide rate of women aged 15–44 years (including pregnant and postpartum women) was 3.6/100,000 females [6]. We would like to thank all the doctors in the different hospitals or other medical settings that helped to gather the information on individual cases. This made it more challenging to categorise some cases. Kallianidis AF, Schutte JM, van Roosmalen J, van den Akker T; Maternal Mortality and Severe Morbidity Audit Committee of the Netherlands Society of Obstetrics and Gynecology. Am J Obstet Gynecol. The average annual rate of reduction in the global maternal mortality ratio was 2.9 per cent. In the last 30 years, a slight reduction in amniotic fluid embolism from the first to the second study period was observed (fig. In 2017, maternal mortality ratio for Switzerland was 5 deaths per 100,000 live births. on behalf of MBRRACE-UK. All postpartum haemorrhage cases should be subject to critical review. She developed heparin induced thrombocytaemia and died as a result. To assess underreporting of maternal deaths in Switzerland, the archive of the Institute of Forensic Medicine (IRM) was additionally searched for deaths in connection with pregnancy, childbirth and the puerperium. More than half (62.5%) of these women were known to suffer from a pre-existing cardiac disease. Article in German. Switzerland Maternal Mortality Rate 2000-2021, Switzerland maternal mortality rate for 2017 was, Switzerland maternal mortality rate for 2016 was, Switzerland maternal mortality rate for 2015 was, Switzerland maternal mortality rate for 2014 was. 15 World Health Organisation. 2003;43(3):158–65. Lebendgeburten nach Alter der Mutter und Kanton 2015. 18 Main EK, Goffman D, Scavone BM, Low LK, Bingham D, Fontaine PL, et al. ; United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group. European Perinatal Health Report 2010 - Health and Care of Pregnant Women and Babies in Europe in 2010. For classifying the lethality of caesarean section, the death had to be temporally linked to the operation and the cause of death needed to be directly related to surgery [5]. Lebendgeburten nach Alter der Mutter 2018. (Obstetric death of unspecified cause), The number of maternal deaths during a given time period per 100,000 live births during the same time period, Deaths resulting from obstetric complications in the pregnant state (pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above, Deaths resulting from previously existing disease, or any disease that developed during pregnancy and was not the result of direct obstetric causes, but which was aggravated by the physiological effects of pregnancy, Deaths from unrelated causes which happen to occur in pregnancy or the puerperium, Deaths occurring between 42 days and 1 year after abortion, miscarriage or delivery that are due to direct or indirect maternal causes. According to the EURO-PERISTAT report in 2010, compared with other European countries, Switzerland had the second highest percentage (41.1%) of mothers who were born abroad, being surpassed only by Luxembourg with 66% [9]. Printed in France. http://dx.doi.org/10.1097/AOG.0000000000000564 PubMed, 13 Zöllner J, Curry R, Johnson M. The contribution of heart disease to maternal mortality. doi:. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. http://dx.doi.org/10.1016/S0140-6736(15)00838-7 PubMed. World Health Organisation. +41 (0)61 467 85 55 Fax +41 (0)61 467 85 56 e-mail: Editorial office, EMH MediaSchweizerische ÄrztezeitungSwiss Medical ForumPrimary and Hospital CareCardiovascular MedicineSwiss Archives of Neurology, Psychiatry and PsychotherapySynapseSwiss Medical Informatics. Maternal and reproductive health Maternal mortality serves as a marker of the performance of the healthcare system and even of prevailing social inequalities. 2018;229:148–52. Haemorrhage was classified as a direct obstetric case, except for one indirect case. Main EK, Goffman D, Scavone BM, Low LK, Bingham D, Fontaine PL, et al. Increasing maternal age is a known risk factor for adverse outcomes in obstetrics, since it is often associated with other morbidities that are becoming more common in the childbearing population [12]. Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. Solely relying on the visual assessment of blood loss is insufficient as it is underestimated routinely by 30–50% [18]. Despite this reduction, after examining each individual case, the assessors of MBRRACE-UK felt that improvements in care might have made a difference in the outcome in 93% of cases [14]. 2015;125(1):5–12. The Federal Statistical Office (FSO) provided all death certificates between 2005 and 2014 with an ICD-10 code in the obstetric field (indicated with the letter O). No further information on psychological status was available. The search terms included “maternal mortality”, “maternal death” and “maternal morbidity”. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Suicide was the leading cause of maternal deaths, had suicides been classified as direct obstetric cases. The cases were classified according to ICD-10 as “direct”, “indirect”, “non-pregnancy-related”, and “late” deaths. doi:. 17 Surbek D, Hess T, Drack G. Expertenbriefe Nr. In order to reduce underreporting, the WHO introduced in 2012 the International Classification of Disease for Maternal Mortality (ICD-MM), in which all suicides during pregnancy and up to a year after the birth are to be classified as direct obstetric deaths [15]. If you use our chart images on your site or blog, we ask that you provide attribution via a link back to this page. doi:. A further limitation was the small numbers used for analysis as a result of missing data (e.g., mode of delivery), which made it difficult to obtain statistically significant results. In 13 cases, death was classified as suicide. This also allowed a direct comparison with the previous study periods. Cause of death in relation to caesarean section (vaginal deliveries = 67.9% of 787,007 live births). 2). Although this had no effect on the direct maternal mortality ratio, the rate of underreporting for all maternal mortality cases was 11.1%. The global maternal mortality ratio in 2017 is estimated at 211deaths per 100,000 live births, a 38 per cent reduction since 2000, when it was estimated at 342. 9 EURO-PERISTAT Project with SCPE and EUROCAT. 2019;134(4):881–2. http://dx.doi.org/10.4414/smw.2010.12768 PubMed, 5 Kallianidis AF, Schutte JM, van Roosmalen J, van den Akker T; Maternal Mortality and Severe Morbidity Audit Committee of the Netherlands Society of Obstetrics and Gynecology. Ann Intern Med. Since that increase, a reduction in maternal mortality due to haemorrhage has occurred (fig. The physician who had signed the death certificate, or the corresponding clinic, was asked to complete an anonymous questionnaire on further information on the circumstances of the deaths. Swiss Archives of Neurology, Psychiatry and Psychotherapy, http://dx.doi.org/10.1016/S0140-6736(15)00838-7, http://dx.doi.org/10.1016/j.ejogrb.2018.08.586, https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffentlichungen.assetdetail.11348164.html, https://www.bfs.admin.ch/bfs/de/home.assetdetail.13187342.html, https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/geburten-todesfaelle/geburten.html, http://dx.doi.org/10.1097/AOG.0000000000003497, http://dx.doi.org/10.1097/AOG.0000000000000564, http://dx.doi.org/10.1097/GCO.0b013e32835e0f11, http://dx.doi.org/10.1016/j.ajog.2019.02.056, http://dx.doi.org/10.1097/AOG.0000000000000869, http://dx.doi.org/10.1016/0002-9378(95)91474-9, http://dx.doi.org/10.21037/cdt.2017.10.08, http://dx.doi.org/10.7326/0003-4819-143-10-200511150-00006, http://dx.doi.org/10.1007/s10995-013-1403-x, http://dx.doi.org/10.1186/s12916-018-1064-0, I46.9 (Cardiac arrest, cause unspecified), I49.0 (I49.0 - Ventricular fibrillation and flutter), R99. and by 40.4% compared with that in 1985–1994 (5.54/100,000) (OR 0.6, 95% CI 0.37–0.97; p = 0.04). 2016–00240). 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