Saving mothers´ lives through better care

Publishing researchers: Lill Trine Nyfløt, Siri Vangen

Background

A maternal death is defined as the death of a woman while pregnant or within 42 days of the end of the pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Such deaths are further divided into direct and indirect deaths. Direct maternal deaths are defined as deaths resulting from obstetric complications of interventions, omissions, and/or incorrect treatment, or from a chain of events resulting from any of the above. Indirect deaths are defined as a death resulting from previous existing disease, or disease that developed during pregnancy and was aggravated by the physiological effects of pregnancy.

The decrease in maternal deaths in high income countries after World War II is the most impressive health effect the world has witnessed. All causes of deaths decreased sharply, in particular severe infections, haemorrhage and hypertensive pregnancy disorders. The development of modern medicine, with the introduction of antibiotics, blood transfusions and surgery, played an important role, in combination with hospital deliveries and antenatal care for all pregnant women. In recent years, an increase in maternal mortality ratio has been reported by the World Health Organization (WHO). This is probably due to the changing nature of maternal health, such as age, obesity and co-morbidity. Socio-demographic factors such as migrant status have also been shown to be associated with maternal deaths.

Maternal care in Norway is among the best in the world and the number of maternal deaths is low. However, maternal age is increasing and pre-existing diseases has become increasingly more common among pregnant women, representing a risk factor for maternal death. More knowledge is warranted about the treatment- and follow up of pre-existing diseases in pregnancy.

Research has shown that avoidable maternal deaths due to substandard care still happen in Norway. Identification of maternal deaths are essential to identify avoidable maternal deaths and their causes. Norway has no valid system in place for registration and assessment of maternal deaths. Consequently, around 50 % of deaths related to pregnancy and childbirth are missing in official statistics and the numbers and causes of the most serious outcome of birth are unknown. This situation represents a missed opportunity to learn from such tragedies. Close scrutiny of the chain of events leading to the tragedy has a unique learning potential.

About the project

For every mother who dies, more than 100 women will experience a severe complication that left untreated or if treatment is delayed, may lead to a long-term complication or death. Hence, the results of the current study also inherit the potential to reduce the number of women with serious pregnancy complication, often profoundly affecting their short- and long-term health.

The project has an associated audit group consisting of obstetricians from all 5 health regions in Norway, a general practitioner, an anesthesiologist, a cardiologist and a midwife. Through translation of suboptimal care factors to clinical advice for obstetric care, we aim to reduce the number of deaths related to pregnancy and childbirth.

The results of the study may contribute to strengthen health personnel’s capacity to cope with severe obstetric complications by updating existing clinical guidelines for the management of severe complications accordingly, and by establishing a clinical risk management plan in each maternity unit.

Goals and achievements

We aim to identify the numbers, causes and suboptimal care factors of all maternal deaths in Norway using a combined method of registry linkage, active case finding and audit assessment of each maternal death.

The project has published two reports:

Hvorfor dør kvinner i graviditet i dag? Mødredødsfall i Norge fra1996-2011
Hvorfor dør kvinner i graviditet i dag? Mødredødsfall i Norge fra1996-2011

The published reports can be downloaded here (PDF, In Norwegian).

Several scientific papers on maternal deaths have been published

Number and causes of maternal deaths in Norway and in the Nordic countries
Maternal deaths from hypertensive diseases in pregnancy – lessons learnt.
Impact of cardiovascular diseases on maternal deaths in the Nordic countries
Strategies to reduce global maternal mortality.
COVID-19 in pregnancy - characteristics and outcomes of pregnant women
Pregnancy, birth and the postnatal period – more than just survival

Collacorators

NGF (Norsk Gynekologisk Forening)
Nordic Maternal Mortality collaboration
NOSS (Nordic Obstetric Surveillance System)
INOSS (INternational Obstetric Surveillance System)
NIPH (Norwegian Institute of Public Health) to provide even stronger scientific evidence and improve the surveillance of these tragic incidences.