Author:
Lameijer H., ,Schutte J. M.,Schuitemaker N. W. E.,van Roosmalen J. J. M.,Pieper P. G.
Abstract
Abstract
Objective
Cardiovascular disorders are the leading cause of indirect maternal mortality in Europe. The aim of this study is to present an extensive overview concerning the specific cardiovascular causes of maternal death and to identify avoidable contributing care factors related to these deaths.
Methods
We assessed all cases of maternal death due to cardiovascular disorders collected by a systematic national confidential enquiry of maternal deaths published by the Dutch Maternal Mortality and Morbidity Committee on behalf of the Netherlands Society of Obstetrics and Gynaecology over a 21-year period (1993–2013) in the Netherlands.
Results
There were 96 maternal cardiovascular deaths (maternal mortality rate due to cardiovascular diseases 2.4/100,000 liveborn children). Causes were aortic dissection (n = 20, 21%), ischaemic heart disease (n = 17, 18%), cardiomyopathies (including peripartum cardiomyopathy and myocarditis, n = 20, 21%) and (unexplained) sudden death (n = 27, 28%). Fifty-five percent of the deaths occurred postpartum (n = 55, 55%). Care factors that may have contributed to the adverse outcome were identified in 27 cases (28%). These factors were patient-related in 40% (pregnancy against medical advice, underestimation of symptoms) and healthcare-provider-related in 60% (symptoms not recognised, delay in diagnosis, delay in referral).
Conclusion
The maternal cardiovascular mortality ratio is low in the Netherlands and the main causes of maternal cardiovascular mortality are in line with other European reports. In a minority of cases, care factors that were possibly preventable were identified. Women with cardiovascular disease should be properly counselled about the risks of pregnancy and the symptoms of complications. Education of care providers regarding the incidence, presentation and diagnosis of cardiovascular disease during pregnancy is recommended.
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine
Reference34 articles.
1. Cantwell R, Clutton-Brock T, Cooper G, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118(Suppl 1):1–203.
2. Schutte JM, de Jonge L, Schuitemaker NW, et al. Indirect maternal mortality increases in the Netherlands. Acta Obstet Gynecol Scand. 2010;89:762–8.
3. Schutte JM, Steegers EA, Schuitemaker NW, et al. Rise in maternal mortality in the Netherlands. BJOG. 2010;117:399–406.
4. Engin-Ustun Y, Celen S, Ozcan A, et al. Maternal mortality from cardiac disease in Turkey: a population-based study. J Matern Fetal Neonatal Med. 2012;25:2451–3.
5. WHO. International classification of diseases. Manual of the international classification of diseases, injuries and causes of death. Based on the recommendations of the 10th Revision Conference. Vol. 1. Geneva: World Health Organisation; 1992.
Cited by
17 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献