Confidential enquiry into maternal deaths in the Netherlands, 2006-2018:
a retrospective cohort study
Abstract
Objective: To calculate maternal mortality ratio (MMR) for 2006-2018 in
the Netherlands and compare with 1993-2005. Describe women’s and
obstetric characteristics, causes of death and improvable factors.
Design: Prospective cohort study. Setting: Nationwide. Population:
2,304,271 livebirths. Methods: Analysis of all maternal deaths between
January 1st, 2006, and December, 31st, 2018 as reported to and audited
by the national Audit Committee Maternal Mortality and Morbidity. Main
outcome measures: MMR, causes of death, improvable factors. Results:
Overall MMR was 6.2 per 100,000 livebirths, a decrease from 12.1 in
1993-2005 (Odds Ratio (OR) 0.5, 95%CI 0.4-0.6). Women with non-Western
ethnic background had a slightly increased MMR compared to Dutch women
(MMR 6.5 vs 5.0, OR 1.3, 95%CI 0.9-1.9), and was particularly increased
among women with a background from Surinam/Dutch Antilles (MMR 14.7 OR
2.9, 95%CI 1.6 – 5.3). Half of all women had an uncomplicated medical
history (79/161, 49.1%). Of 172 pregnancy-related deaths within one
year postpartum, 103 (60%) had a direct and 69 (40%) an indirect
cause. Leading causes within 42 days postpartum were cardiac disease
(n=21, 14.8%), hypertensive disorders (n=20, 14.1%) and thrombosis
(n=19, 13.4%). For deaths up to one year postpartum, suicide was the
third commonest cause (n=20, 11.6%). Improvable factors in care were
identified in 76 (47.5%) of all deaths. Conclusions: Maternal mortality
halved in 2006-2018 compared to 1993-2005. Unlike before, cardiac
disease outnumbered hypertensive disorders as main cause of death. Women
with a background from Surinam/Dutch Antilles had a threefold higher
risk of death compared to Dutch women.