title: Pregnancy-related deaths in four regions of Europe and the United States in 1999-2000: characterisation of unreported deaths.
abstract: OBJECTIVE
  We compared official maternal mortality statistics with those from a special study covering all pregnancy-associated deaths in two European countries (Finland and France) and in two US states (Massachusetts and North Carolina) in 1999-2000 to characterize pregnancy-related deaths that are not included in official statistics.
  
  
  METHODS
  We linked the official ICD-10-based maternal mortality data for 84 deaths with study data on 404 pregnancy-associated deaths.
  
  
  RESULTS
  Of the pregnancy-associated deaths, 151 were pregnancy-related. We found 69 pregnancy-related deaths that had not been included as maternal deaths, and two deaths coded as maternal deaths that did not meet our definition for a pregnancy-related death. In total, 58 of these 69 deaths were from medical causes and 11 were from external causes or injuries (10 postpartum depression-related suicides and one accidental drug poisoning). The unreported deaths due to medical causes included 27 direct, 15 indirect, and two direct/indirect pregnancy-related deaths and 14 possibly pregnancy-related deaths. The most common causes of the unreported deaths due to medical causes were intracerebral hemorrhage (7 deaths), peripartum cardiomyopathy (4), pulmonary embolism (4) and pregnancy-induced hypertension (4).
  
  
  CONCLUSIONS
  The collection of data on pregnancy-related and pregnancy-associated deaths is useful for countries with low maternal mortality figures. The use of various data-collection methods may substantially increase the quality of maternal mortality statistics.
authors.affiliation: STAKES (National Research and Development Centre for Welfare and Health), Information Division, Helsinki, Finland. mika.gissler@stakes.fi
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
authors.forename: Sophie
authors.initials: S
authors.lastname: Alexander
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Berg
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Angela
authors.initials: A
authors.lastname: Nannini
authors.forename: Gerard
authors.initials: G
authors.lastname: Bréart
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
mesh_terms: D005260:Female; D005387:Finland / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D008428:Maternal Mortality; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy