Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

Abstract

Objective: To determine the incidence of maternal deaths attributable to vascular dissection and rupture in the Netherlands, and to assess clinical features, risk factors and the frequency of substandard care in the cases identified.

Design: Confidential enquiry into the causes of maternal deaths.

Setting: Nationwide in the Netherlands.

Population: A total of 3,108,235 live births.

Methods: Data analysis of all cases of maternal death from vascular dissection and rupture in the period 1993-2008. A literature review was also performed.

Main outcome measures: Incidence, clinical features, risk factors and frequency of substandard care.

Results: A total of 23 maternal deaths attributable to vascular dissection and rupture were reported. In most cases the location was aortic (n=13), followed by coronary (n=4) and splenic (n=3) arteries. Clinical features were various, but most women presented with sudden unexplainable pain. Risk factors were present in 14 cases (61%), with hypertension being most frequently reported in ten cases (43%). Substandard care was determined to have been received in 13 cases (56%), inadequate assessment of complaints and a delay in diagnosis being the most frequent problems identified.

Conclusions: Vascular dissection and rupture in pregnancy, although rare, carry a high risk of maternal and fetal morbidity and mortality. Because of the rarity of this condition and its variety in presentation, diagnosis is easily missed. A high index of suspicion when a woman presents with suggestive complaints, leading to an early diagnosis, may improve the prognosis for the woman and her child.