Maraschini Alice, Mandolini Donatella, Lega Ilaria, D'Aloja Paola, Decenti Edoardo Corsi, Baglio Giovanni, Minelli Giada, Donati Serena
Statistical Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
National Centre for Diseases Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Sci Rep. 2024 Dec 30;14(1):31640. doi: 10.1038/s41598-024-80431-0.
This study aimed to calculate Italy's first national maternal mortality ratio (MMR) through an innovative record-linkage approach within the enhanced Italian Obstetric Surveillance System (ItOSS). A record-linkage retrospective cohort study was conducted nationwide, encompassing all women aged 11-59 years with one or more hospitalizations related to pregnancy or pregnancy outcomes from 2011 to 2019. Maternal deaths were identified by integrating data from the Death Registry and national and regional Hospital Discharge Databases supported by the integration of findings from confidential enquiries conducted through active surveillance. Maternal Mortality Ratio (MMR), direct MMR (DMMR), and causes of maternal death are the study main outcomes. The MMR was found to be 8.4 per 100,000 live births (95% CI 7.5-9.3), significantly higher than the 3.9 per 100,000 (95% CI 3.3-4.5) calculated solely from the Death Registry, with a notable declining trend over the study period. Causes of death have been classified according to the 10th International Classification of Diseases. Within 42 days from pregnancy outcome, leading causes were obstetric haemorrhage, sepsis, and cardiovascular diseases. Late maternal deaths were primarily attributed to suicide, malignancies, and cardiovascular diseases. This integrated methodology provides a comprehensive understanding of maternal mortality trends and causes in Italy, offering valuable insights for countries utilizing or planning enhanced surveillance systems.
本研究旨在通过意大利强化产科监测系统（ItOSS）内的创新记录链接方法，计算意大利首个全国孕产妇死亡率（MMR）。在全国范围内开展了一项记录链接回顾性队列研究，涵盖了2011年至2019年期间所有年龄在11至59岁、因妊娠或妊娠结局而有一次或多次住院治疗的妇女。通过整合死亡登记处的数据以及国家和地区医院出院数据库的数据，并结合通过主动监测进行的保密调查结果，确定孕产妇死亡情况。孕产妇死亡率（MMR）、直接孕产妇死亡率（DMMR）以及孕产妇死亡原因是本研究的主要结果。研究发现，孕产妇死亡率为每10万例活产8.4例（95%置信区间7.5 - 9.3），显著高于仅根据死亡登记处计算得出的每10万例3.9例（95%置信区间3.3 - 4.5），且在研究期间呈明显下降趋势。死亡原因已根据第十版《国际疾病分类》进行分类。在妊娠结局后的42天内，主要死因是产科出血、败血症和心血管疾病。晚期孕产妇死亡主要归因于自杀、恶性肿瘤和心血管疾病。这种综合方法全面了解了意大利的孕产妇死亡趋势和原因，为使用或计划强化监测系统的国家提供了有价值的见解。
