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J. Van Roosmalen - One of the best experts on this subject based on the ideXlab platform.
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Regional differences in Dutch Maternal Mortality
BJOG : an international journal of obstetrics and gynaecology, 2012Co-Authors: J.p. De Graaf, Joke M. Schutte, Jashvant Poeran, J. Van Roosmalen, Gouke J. Bonsel, Eric A.p. SteegersAbstract:Please cite this paper as: de Graaf J, Schutte J, Poeran J, van Roosmalen J, Bonsel G, Steegers E. Regional differences in Dutch Maternal Mortality. BJOG 2012;119:582–588. Objective To study regional differences in Maternal Mortality in the Netherlands. Design Confidential inquiry into the causes of Maternal Mortality. Setting Nationwide. Population A total of 3 108 235 live births and 337 Maternal deaths. Methods Data analysis of all Maternal deaths in the period 1993–2008. Main outcome measure Maternal Mortality. Results The overall national Maternal Mortality ratio was 10.8 per 100 000 live births. In the 12 provinces of the Netherlands, the Maternal Mortality ratio ranged from 6.2 in Noord Brabant to 16.3 per 100 000 live births in Zeeland. In the four largest cities, Maternal Mortality varied from 9.3 in Amsterdam to 21.0 in Rotterdam. At a national level, the most frequent direct cause was pre-eclampsia. Increased risks for Maternal Mortality were found for women living in deprived neighbourhoods (RR 1.41), women from non-Western origin (RR 1.59), and women who were 35 years or older (RR 1.61). Conclusion There are significant variations in Maternal Mortality ratios in the Netherlands between cities, provinces, and neighbourhoods. In addition, higher Maternal Mortality was observed in women of non-Western origin and in women who were 35 years of age or older.
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rise in Maternal Mortality in the netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (<20 years of age), women aged 45 years and above, and women in the immigrant population. Most substandard care during the study period occurred among women with preeclampsia (91%) and in immigrant populations (62%). These findings show an alarming increase in MMR in the Netherlands during the years 1993-2005 compared to the 1983-1992 period. As in the earlier study period, preeclampsia is the leading cause of Maternal Mortality. Substandard care is a major concern. The investigators recommend that health professionals and women at increased risk for preeclampsia and other complications during pregnancy should be educated about the danger signs for such complications. In addition, professionals require better training to manage these complications and prevent them when possible.
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Indirect Maternal Mortality increases in the Netherlands
Acta obstetricia et gynecologica Scandinavica, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Layla De Jonge, Job G. Santema, J. Van RoosmalenAbstract:AbstractObjective. To assess causes, trends, and substandard care in indirect Maternal Mortality in the Netherlands. Design. Confidential enquiry into causes of Maternal death. Setting. Nationwide in the Netherlands. Population. A total of 2,557,208 live births. Methods. Data analysis of indirect Maternal deaths in the period 1993–2005. Main outcome measures. Indirect Maternal Mortality. Results. Of the study subjects, 97 were classified as indirect deaths, representing a Maternal Mortality ratio of 3.3/100,000 live births, a significant increase compared to the preceding enquiry in the period 1983–1992 (MMR 2.4, OR 1.5, 95%CI 1.0–2.1). The percentage of cases not directly reported to the Maternal Mortality Committee decreased from 15 to 5%. Cardiovascular disorders were the leading cause of indirect Maternal Mortality, followed by cerebrovascular disorders. Vascular dissection (n = 19) was the most frequent specified cause of death. Risk factors were advanced Maternal age, non-indigenous origin (Surinam ...
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Rise in Maternal Mortality in The Netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (
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Rise in Maternal Mortality in the Netherlands.
BJOG : an international journal of obstetrics and gynaecology, 2009Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:Objective To assess causes, trends and substandard care factors in Maternal Mortality in the Netherlands. Design Confidential enquiry into the causes of Maternal Mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all Maternal deaths in the period 1993-2005. Main outcome measures Maternal Mortality. Results The overall Maternal Mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the Maternal Mortality ratio of 9.7 in the period 1983-1992 (OR 1.2, 95% CI 1.0-1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4-4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions Maternal Mortality in the Netherlands has increased since 1983-1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve Maternal health care.
Eric A.p. Steegers - One of the best experts on this subject based on the ideXlab platform.
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Regional differences in Dutch Maternal Mortality
BJOG : an international journal of obstetrics and gynaecology, 2012Co-Authors: J.p. De Graaf, Joke M. Schutte, Jashvant Poeran, J. Van Roosmalen, Gouke J. Bonsel, Eric A.p. SteegersAbstract:Please cite this paper as: de Graaf J, Schutte J, Poeran J, van Roosmalen J, Bonsel G, Steegers E. Regional differences in Dutch Maternal Mortality. BJOG 2012;119:582–588. Objective To study regional differences in Maternal Mortality in the Netherlands. Design Confidential inquiry into the causes of Maternal Mortality. Setting Nationwide. Population A total of 3 108 235 live births and 337 Maternal deaths. Methods Data analysis of all Maternal deaths in the period 1993–2008. Main outcome measure Maternal Mortality. Results The overall national Maternal Mortality ratio was 10.8 per 100 000 live births. In the 12 provinces of the Netherlands, the Maternal Mortality ratio ranged from 6.2 in Noord Brabant to 16.3 per 100 000 live births in Zeeland. In the four largest cities, Maternal Mortality varied from 9.3 in Amsterdam to 21.0 in Rotterdam. At a national level, the most frequent direct cause was pre-eclampsia. Increased risks for Maternal Mortality were found for women living in deprived neighbourhoods (RR 1.41), women from non-Western origin (RR 1.59), and women who were 35 years or older (RR 1.61). Conclusion There are significant variations in Maternal Mortality ratios in the Netherlands between cities, provinces, and neighbourhoods. In addition, higher Maternal Mortality was observed in women of non-Western origin and in women who were 35 years of age or older.
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rise in Maternal Mortality in the netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (<20 years of age), women aged 45 years and above, and women in the immigrant population. Most substandard care during the study period occurred among women with preeclampsia (91%) and in immigrant populations (62%). These findings show an alarming increase in MMR in the Netherlands during the years 1993-2005 compared to the 1983-1992 period. As in the earlier study period, preeclampsia is the leading cause of Maternal Mortality. Substandard care is a major concern. The investigators recommend that health professionals and women at increased risk for preeclampsia and other complications during pregnancy should be educated about the danger signs for such complications. In addition, professionals require better training to manage these complications and prevent them when possible.
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Indirect Maternal Mortality increases in the Netherlands
Acta obstetricia et gynecologica Scandinavica, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Layla De Jonge, Job G. Santema, J. Van RoosmalenAbstract:AbstractObjective. To assess causes, trends, and substandard care in indirect Maternal Mortality in the Netherlands. Design. Confidential enquiry into causes of Maternal death. Setting. Nationwide in the Netherlands. Population. A total of 2,557,208 live births. Methods. Data analysis of indirect Maternal deaths in the period 1993–2005. Main outcome measures. Indirect Maternal Mortality. Results. Of the study subjects, 97 were classified as indirect deaths, representing a Maternal Mortality ratio of 3.3/100,000 live births, a significant increase compared to the preceding enquiry in the period 1983–1992 (MMR 2.4, OR 1.5, 95%CI 1.0–2.1). The percentage of cases not directly reported to the Maternal Mortality Committee decreased from 15 to 5%. Cardiovascular disorders were the leading cause of indirect Maternal Mortality, followed by cerebrovascular disorders. Vascular dissection (n = 19) was the most frequent specified cause of death. Risk factors were advanced Maternal age, non-indigenous origin (Surinam ...
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Rise in Maternal Mortality in The Netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (
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Rise in Maternal Mortality in the Netherlands.
BJOG : an international journal of obstetrics and gynaecology, 2009Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:Objective To assess causes, trends and substandard care factors in Maternal Mortality in the Netherlands. Design Confidential enquiry into the causes of Maternal Mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all Maternal deaths in the period 1993-2005. Main outcome measures Maternal Mortality. Results The overall Maternal Mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the Maternal Mortality ratio of 9.7 in the period 1983-1992 (OR 1.2, 95% CI 1.0-1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4-4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions Maternal Mortality in the Netherlands has increased since 1983-1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve Maternal health care.
Gary D.v. Hankins - One of the best experts on this subject based on the ideXlab platform.
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Maternal Mortality in Texas.
American journal of perinatology, 2016Co-Authors: Sonia Baeva, Natalie P. Archer, Karen Ruggiero, Manda Hall, Julie Stagg, Evelyn Coronado Interis, Rachelle Vega, Evelyn Delgado, John Hellerstedt, Gary D.v. HankinsAbstract:A commentary on Maternal Mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that Maternal Mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the Maternal Mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying Maternal death are also discussed, as well as risk factors and causes of Maternal death in Texas. Finally, several state efforts currently underway to address Maternal Mortality in Texas are described.
Joke M. Schutte - One of the best experts on this subject based on the ideXlab platform.
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Regional differences in Dutch Maternal Mortality
BJOG : an international journal of obstetrics and gynaecology, 2012Co-Authors: J.p. De Graaf, Joke M. Schutte, Jashvant Poeran, J. Van Roosmalen, Gouke J. Bonsel, Eric A.p. SteegersAbstract:Please cite this paper as: de Graaf J, Schutte J, Poeran J, van Roosmalen J, Bonsel G, Steegers E. Regional differences in Dutch Maternal Mortality. BJOG 2012;119:582–588. Objective To study regional differences in Maternal Mortality in the Netherlands. Design Confidential inquiry into the causes of Maternal Mortality. Setting Nationwide. Population A total of 3 108 235 live births and 337 Maternal deaths. Methods Data analysis of all Maternal deaths in the period 1993–2008. Main outcome measure Maternal Mortality. Results The overall national Maternal Mortality ratio was 10.8 per 100 000 live births. In the 12 provinces of the Netherlands, the Maternal Mortality ratio ranged from 6.2 in Noord Brabant to 16.3 per 100 000 live births in Zeeland. In the four largest cities, Maternal Mortality varied from 9.3 in Amsterdam to 21.0 in Rotterdam. At a national level, the most frequent direct cause was pre-eclampsia. Increased risks for Maternal Mortality were found for women living in deprived neighbourhoods (RR 1.41), women from non-Western origin (RR 1.59), and women who were 35 years or older (RR 1.61). Conclusion There are significant variations in Maternal Mortality ratios in the Netherlands between cities, provinces, and neighbourhoods. In addition, higher Maternal Mortality was observed in women of non-Western origin and in women who were 35 years of age or older.
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rise in Maternal Mortality in the netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (<20 years of age), women aged 45 years and above, and women in the immigrant population. Most substandard care during the study period occurred among women with preeclampsia (91%) and in immigrant populations (62%). These findings show an alarming increase in MMR in the Netherlands during the years 1993-2005 compared to the 1983-1992 period. As in the earlier study period, preeclampsia is the leading cause of Maternal Mortality. Substandard care is a major concern. The investigators recommend that health professionals and women at increased risk for preeclampsia and other complications during pregnancy should be educated about the danger signs for such complications. In addition, professionals require better training to manage these complications and prevent them when possible.
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Indirect Maternal Mortality increases in the Netherlands
Acta obstetricia et gynecologica Scandinavica, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Layla De Jonge, Job G. Santema, J. Van RoosmalenAbstract:AbstractObjective. To assess causes, trends, and substandard care in indirect Maternal Mortality in the Netherlands. Design. Confidential enquiry into causes of Maternal death. Setting. Nationwide in the Netherlands. Population. A total of 2,557,208 live births. Methods. Data analysis of indirect Maternal deaths in the period 1993–2005. Main outcome measures. Indirect Maternal Mortality. Results. Of the study subjects, 97 were classified as indirect deaths, representing a Maternal Mortality ratio of 3.3/100,000 live births, a significant increase compared to the preceding enquiry in the period 1983–1992 (MMR 2.4, OR 1.5, 95%CI 1.0–2.1). The percentage of cases not directly reported to the Maternal Mortality Committee decreased from 15 to 5%. Cardiovascular disorders were the leading cause of indirect Maternal Mortality, followed by cerebrovascular disorders. Vascular dissection (n = 19) was the most frequent specified cause of death. Risk factors were advanced Maternal age, non-indigenous origin (Surinam ...
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Rise in Maternal Mortality in The Netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (
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Rise in Maternal Mortality in the Netherlands.
BJOG : an international journal of obstetrics and gynaecology, 2009Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:Objective To assess causes, trends and substandard care factors in Maternal Mortality in the Netherlands. Design Confidential enquiry into the causes of Maternal Mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all Maternal deaths in the period 1993-2005. Main outcome measures Maternal Mortality. Results The overall Maternal Mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the Maternal Mortality ratio of 9.7 in the period 1983-1992 (OR 1.2, 95% CI 1.0-1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4-4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions Maternal Mortality in the Netherlands has increased since 1983-1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve Maternal health care.
Nico W.e. Schuitemaker - One of the best experts on this subject based on the ideXlab platform.
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rise in Maternal Mortality in the netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (<20 years of age), women aged 45 years and above, and women in the immigrant population. Most substandard care during the study period occurred among women with preeclampsia (91%) and in immigrant populations (62%). These findings show an alarming increase in MMR in the Netherlands during the years 1993-2005 compared to the 1983-1992 period. As in the earlier study period, preeclampsia is the leading cause of Maternal Mortality. Substandard care is a major concern. The investigators recommend that health professionals and women at increased risk for preeclampsia and other complications during pregnancy should be educated about the danger signs for such complications. In addition, professionals require better training to manage these complications and prevent them when possible.
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Indirect Maternal Mortality increases in the Netherlands
Acta obstetricia et gynecologica Scandinavica, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Layla De Jonge, Job G. Santema, J. Van RoosmalenAbstract:AbstractObjective. To assess causes, trends, and substandard care in indirect Maternal Mortality in the Netherlands. Design. Confidential enquiry into causes of Maternal death. Setting. Nationwide in the Netherlands. Population. A total of 2,557,208 live births. Methods. Data analysis of indirect Maternal deaths in the period 1993–2005. Main outcome measures. Indirect Maternal Mortality. Results. Of the study subjects, 97 were classified as indirect deaths, representing a Maternal Mortality ratio of 3.3/100,000 live births, a significant increase compared to the preceding enquiry in the period 1983–1992 (MMR 2.4, OR 1.5, 95%CI 1.0–2.1). The percentage of cases not directly reported to the Maternal Mortality Committee decreased from 15 to 5%. Cardiovascular disorders were the leading cause of indirect Maternal Mortality, followed by cerebrovascular disorders. Vascular dissection (n = 19) was the most frequent specified cause of death. Risk factors were advanced Maternal age, non-indigenous origin (Surinam ...
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Rise in Maternal Mortality in The Netherlands
Obstetrical & Gynecological Survey, 2010Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:This report of the Dutch Maternal Mortality Committee analyzes Maternal deaths occurring in the Netherlands between 1993 and 2005 with respect to causes, trends, and substandard care factors in Maternal Mortality. The findings were compared with those of an initial report covering the years 1983-1992 published by the Maternal Mortality Committee in 1998. The primary study outcome was Maternal Mortality expressed as the Maternal Mortality ratio (MMR), which is defined as the number of direct and indirect Maternal deaths per 100,000 live births up to 42 days after the termination of pregnancy. A total of 2,557,208 live births occurred during the study period. Between 1993 and 2005, the MMR was 12.1 per 100,000 live births (309/2,557,208), which was significantly higher compared with the period 1983-1992 (MMR: 9.7); the odds ratio (OR) was 1.2, with a 95% confidence interval (CI) of 1.0 to 1.5. Preeclampsia was the leading cause of Maternal Mortality, accounting for 39.4% of all direct Maternal deaths. Other direct causes of Maternal death included thromboembolism (18.6%), sudden death in pregnancy (9.3%), genital tract sepsis (8.5%), obstetric hemorrhage (7.6%), and amniotic fluid embolism (4.7%). All direct causes occurred more frequently than in the period 1983-1992, but the differences were not statistically significant. Compared to 1983-1992, there was a statistically significant increase in the number of indirect deaths during the study period, primarily due to an increase in the number of cardiovascular disorders (OR: 2.5; 95% CI: 1.4―4.6). The highest risks for Maternal death were found in teenagers (
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Rise in Maternal Mortality in the Netherlands.
BJOG : an international journal of obstetrics and gynaecology, 2009Co-Authors: Joke M. Schutte, Nico W.e. Schuitemaker, Eric A.p. Steegers, Job G. Santema, K. De Boer, M. Pel, G. Vermeulen, W. Visser, J. Van RoosmalenAbstract:Objective To assess causes, trends and substandard care factors in Maternal Mortality in the Netherlands. Design Confidential enquiry into the causes of Maternal Mortality. Setting Nationwide in the Netherlands. Population 2,557,208 live births. Methods Data analysis of all Maternal deaths in the period 1993-2005. Main outcome measures Maternal Mortality. Results The overall Maternal Mortality ratio was 12.1 per 100 000 live births, which was a statistically significant rise compared with the Maternal Mortality ratio of 9.7 in the period 1983-1992 (OR 1.2, 95% CI 1.0-1.5). The most frequent direct causes were (pre-)eclampsia, thromboembolism, sudden death in pregnancy, sepsis, obstetric haemorrhage and amniotic fluid embolism. The number of indirect deaths also increased, mainly caused by an increase in cardiovascular disorders (OR 2.5, 95% CI 1.4-4.6). Women younger than 20 years and older than 45 years, those with high parity or from nonwestern immigrant populations were at higher risk. Most substandard care was found in women with pre-eclampsia (91%) and in immigrant populations (62%). Conclusions Maternal Mortality in the Netherlands has increased since 1983-1992. Pre-eclampsia remains the number one cause. Groups at higher risk for complications during pregnancy should be better identified early in pregnancy or before conception, in order to receive preconception advice and more frequent antenatal visits. There is an urgent need for the better education of women and professionals concerning the danger signs, and for the training of professionals in order to improve Maternal health care.
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Underreporting of Maternal Mortality in The Netherlands
Obstetrics and gynecology, 1997Co-Authors: Nico W.e. Schuitemaker, G.a. Dekker, J. Van Roosmalen, P.w.j. Van Dongen, H.p. Van Geijn, Jack Bennebroek GravenhorstAbstract:Objective To establish the actual number of Maternal deaths in The Netherlands by determining the degree of underreporting. Methods We conducted a nationwide, retrospective crosscheck of the three available Maternal Mortality registration systems and issued a questionnaire to senior obstetricians in all hospitals during the years 1983–1992. Results The officially reported Maternal Mortality rate during the study period was 7.1 per 100,000 live births (133 Maternal deaths per 1,862,985 live births). After completion of the study, our data indicate that the rate should be at least 9.7 per 100,000 live births (180 Maternal deaths). Early pregnancy and indirect deaths were more likely to be underreported than direct deaths during labor and the puerperium. Failure to register the recent pregnancy on the death certificate was a frequent problem. Misclassification was particularly evident for cerebrovascular disorders, cardiovascular disorders, and eclampsia. Conclusion The level of underreporting of Maternal Mortality in The Netherlands was estimated at 26%. The pregnancy status of women should be registered on death certificates. Officially reported Maternal Mortality rates are unreliable and international comparisons using these data thus are less meaningful.
