National Center for Disease Prevention and Health Promotion, Rome, Italy.
Statistics Service, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy.
Acta Obstet Gynecol Scand. 2018 Nov;97(11):1317-1324. doi: 10.1111/aogs.13415. Epub 2018 Jul 20.
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.
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.
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.
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.
准确估计和可靠分类产妇死亡是减少可避免孕产妇死亡的行动链中的必要步骤。本研究的目的是估计覆盖全国总出生人数 77%的 10 个意大利地区的孕产妇死亡率（MMR），并确定最适合分类死亡原因的方法。
通过死亡登记处和医院出院数据库之间的链接，确定了妊娠期间和妊娠后 1 年内的死亡人数。使用了 2006 年至 2012 年的区域和国家数据源。估计了 MMR，并根据直接或间接原因以及主要死因对死亡进行了分类。
共确定了 277 例妊娠后 42 天内的孕产妇死亡：149 例直接死亡，102 例间接死亡，26 例未分类死亡，导致每 100000 例活产儿中有 9.18 例死亡。参与地区官方 MMR 数据的漏报率为 60.3%。出血（MMR 1.92）、妊娠高血压疾病和心脏病（MMR 1.06）是妊娠后 42 天内死亡的主要原因，而恶性肿瘤（39%）和暴力死亡（17%）是 543 例晚期孕产妇死亡中最常见的原因。
记录链接是一种估计孕产妇死亡率和识别孕产妇死亡原因的有效和可靠方法。直接/间接分类和主要原因分类在直接死亡超过间接孕产妇死亡率的国家都有作用。基于链接数据，机密调查进一步增加了降低孕产妇死亡率的可能性。
