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. 2024 Dec 30;14(1):31640.
doi: 10.1038/s41598-024-80431-0.

Maternal mortality in Italy estimated by the Italian Obstetric Surveillance System

Alice Maraschini  1 , Donatella Mandolini  2 , Ilaria Lega  2 , Paola D'Aloja  2 , Edoardo Corsi Decenti  2 , Giovanni Baglio  3 , Giada Minelli  4 , Serena Donati  2 ; ItOSS Regional Working Group
Collaborators, Affiliations

Maternal mortality in Italy estimated by the Italian Obstetric Surveillance System

Alice Maraschini et al. Sci Rep. .

Abstract

This study aimed to calculate Italy's first national maternal mortality ratio (MMR) through an innovative record-linkage approach within the enhanced Italian Obstetric Surveillance System (ItOSS). A record-linkage retrospective cohort study was conducted nationwide, encompassing all women aged 11-59 years with one or more hospitalizations related to pregnancy or pregnancy outcomes from 2011 to 2019. Maternal deaths were identified by integrating data from the Death Registry and national and regional Hospital Discharge Databases supported by the integration of findings from confidential enquiries conducted through active surveillance. Maternal Mortality Ratio (MMR), direct MMR (DMMR), and causes of maternal death are the study main outcomes. The MMR was found to be 8.4 per 100,000 live births (95% CI 7.5-9.3), significantly higher than the 3.9 per 100,000 (95% CI 3.3-4.5) calculated solely from the Death Registry, with a notable declining trend over the study period. Causes of death have been classified according to the 10th International Classification of Diseases. Within 42 days from pregnancy outcome, leading causes were obstetric haemorrhage, sepsis, and cardiovascular diseases. Late maternal deaths were primarily attributed to suicide, malignancies, and cardiovascular diseases. This integrated methodology provides a comprehensive understanding of maternal mortality trends and causes in Italy, offering valuable insights for countries utilizing or planning enhanced surveillance systems.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This study was approved by the National Ethics Committee of the Italian National Health Institute (Prot. PRE-C318/15, Rome 12/05/2015). The study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Informed consent was not obtained from patients or their families as the study was based on the analysis of institutional forms, and patient records and information were anonymized prior to analysis. All data analysis and processing were conducted in accordance with applicable guidelines and regulations.

Figures

Fig. 1
Fig. 1
Flowchart with the variables obtained from each data source. HDD = Hospital Discharge Database; DR = Death Register; ItOSS = Italian Obstetric Surveillance System.
Fig. 2
Fig. 2
Maternal Mortality Ratio (MMR) calculated using different procedures. Years 2011–2019. *Regions without data from regional record-linkage.
Fig. 3
Fig. 3
Maternal Mortality Ratio (MMR) trend by geographical area rolling 3-year average ratios 2011–2019.
See this image and copyright information in PMC

References

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