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. 2020 Jan;28(1):27-36.
doi: 10.1007/s12471-019-01340-w.

Maternal mortality due to cardiovascular disease in the Netherlands: a 21-year experience

H Lameijer  1   2 , J M Schutte  3 , N W E Schuitemaker  4 , J J M van Roosmalen  5   6 , P G Pieper  7 ; Dutch Maternal Mortality and Morbidity Committee
Affiliations

Maternal mortality due to cardiovascular disease in the Netherlands: a 21-year experience

H Lameijer et al. Neth Heart J. 2020 Jan.

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.

Keywords: Cardiovascular disease; Death; Heart disease; Maternal mortality; Pregnancy.

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Conflict of interest statement

H. Lameijer, J.M. Schutte, N.W.E. Schuitemaker, J.J.M. van Roosmalen and P.G. Pieper declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Causes of death in the women who died during pregnancy or in the postpartum period due to cardiovascular diseases in the UK during 2011–2013 according to the MBRRACE-UK study [16] and in this study during 1993–2013 in the Netherlands. In our study cardiomyopathy includes all cardiomyopathies including peripartum cardiomyopathy and myocarditis
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