Maternal death in Iceland 1976-2015

Ágrip TILGANGUR Mæðradauði er fátíður og alvarlegur atburður, – mælikvarði á umgjörð þungunar og barneigna. Tilgangur rannsóknarinnar var að finna og flokka tilvik á Íslandi samkvæmt alþjóðlegum skilgreiningum og skoða breytingar dánarhlutfalla á 40 ára tímabili. EFNIVIÐUR OG AÐFERÐIR Gögn frá Hagstofu Íslands um konur 15-49 ára sem létust 1985-2015 voru samkeyrð við fæðingaskráninguna og vistunarskrár til að finna konur sem létust á meðgöngu, ≤42 dögum eða innan 43-365 daga frá fæðingu barns eða lokum snemmþungunar. Fyrir árin 1976-1984 var leitað handvirkt. Sjúkraskrár og krufningaskýrslur voru skoðaðar. Dauðsföllin voru flokkuð í bein, óbein eða ótengd og ákvarðað hvort mæðradauði var snemm- eða síðkominn. NIÐURSTÖÐUR Alls létust 1600 konur 15-49 ára, þar af 48 í þungun eða á árinu eftir hana. Fæðingar voru 172.369 og heildartíðni dauðsfalla mæðra ≤365 daga var 27,8/100.000 fæðingar. Mæðradauði samkvæmt skilgreiningu Alþjóðaheilbrigðisstofnunarinnar (bein/óbein tilvik ≤42 dagar) varð í 14 tilvikum, eða 8,1/100.000. Tíðnin lækkaði milli fyrsta og síðasta 10 ára tímabilsins, með mestri lækkun í upphafi og síðan minni lækkun til loka rannsóknartímans. Beintengd dauðsföll voru 6, óbeint tengd 20 og ótengd 22 (slysfarir, sjúkdómar). Orsakir beintengdra dauðsfalla voru alvarleg meðgöngueitrun, lungnablóðrek og fylgjuvefskrabbamein. Óbeint tengd dauðsföll urðu vegna undirliggjandi sjúkdóma, svo sem krabbameins, sykursýki, heila/hjartasjúkdóma og sjálfsvíga. Engin kona lést í tengslum við utanlegsþungun, asablæðingu eða svæfingu/deyfingu. ÁLYKTANIR Mæðradauði á Íslandi er með því lægsta sem þekkist. Konur létust vegna meðgöngunnar, en einnig af versnun undirliggjandi sjúkdómsástands eða ótengdum ástæðum. Árvekni þarf sem fyrr vegna kvenna í áhættuhópum og gagnvart alvarlegum fylgikvillum þungunar og barneigna. INTRODUCTION: Maternal deaths are rare and an indirect measure of the societal framework surrounding pregnancy and childbirth. We surveyed and classified maternal mortality in Iceland using international guidelines, calculating changes over a 40-year period. MATERIAL AND METHODS: Information from Statistics Iceland on women aged 15-49 years who died in 1985-2015 were cross-checked against birth registration and hospital admission data to identify women who died in pregnancy or ≤42 and within 43-365 days from birth or termination of a pregnancy. Data for 1976-1984 were searched manually. Case records and autopsy reports were scrutinized. Deaths were classified as direct, indirect or coincidental and as early or late. RESULTS: Among 1600 women 48 died in pregnancy or within a year after pregnancy. Births totaled 172369 and overall maternal mortality was 27.8/100.000 births. Maternal mortality by World Health Organization criteria (direct/indirect ≤42 days) occurred in 14 instances giving a maternal mortality ratio (MMR) of 8.1/100.000. Rates lowered between the first and last 10-year periods, particularly initially followed by a lesser downward trend. Direct deaths were 6, indirect 20, coincidental 22 (accidents, diseases). Causes of direct deaths were severe preeclampsia, pulmonary embolism and choriocarcinoma. Underlying causes of indirect deaths included cancer, diabetes, brain/heart conditions and suicide. No deaths occurred from ectopic pregnancy, hemorrhage or anesthesia. CONCLUSIONS: Maternal mortality in Iceland is among the lowest reported. Women died because of the pregnancy, from worsening of underlying conditions or coincidentally. Risk groups require better support. Continued attention to adverse health connected to maternity is essential.Peer reviewe

Maternal deaths in Iceland over 25 years.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageMaternal death, during pregnancy or within 42 and 365 days from the end of pregnancy, was evaluated for a small high-income nation with comprehensive healthcare.Cases were identified using record linkage by running national census information on all deaths of women aged 15-49 years during 1985-2009 against the national birth register and computerized hospital admission files for pregnancy-related diagnoses as well as actual case records where needed. Death certificates and hospital records were reviewed.Thirty deaths were identified; 26 at ≥22 weeks (= birth) and four earlier in pregnancy. For 107 871 deliveries, the overall mortality was 27.8/100 000. There were five direct deaths (4.6/100 000 deliveries), five indirect deaths (4.6/100 000 deliveries) and 19 coincidental deaths (17.6/100 000 deliveries). Using WHO criteria (direct and indirect in pregnancy or at ≤42 days postpartum) the ratio was 5.6/100 000 deliveries (95% confidence interval 1.1-10.1) and 5.5/100 000 live births (maternal mortality ratio, based on six deaths). Direct deaths were caused by sepsis, severe preeclampsia and choriocarcinoma, indirect by suicide, pre-existing cardiac and diabetic illness. No woman died of postpartum hemorrhage, anesthesia or ectopic pregnancy. Suboptimal care occurred.Maternal mortality in Iceland over a 25-year period up to the end of year 2010 was low, between 5 and 6/100 000 births. A comprehensive national healthcare system with accessible antenatal care in a society with good general living conditions and universal education probably contributed to this