title: Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands.
abstract: OBJECTIVE
  To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement.
  
  
  METHODS
  Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified.
  
  
  METHODS
  Confidential enquiry by the Dutch Maternal Mortality Committee (MMC) from the Netherlands Society of Obstetrics and Gynaecology.
  
  
  METHODS
  All maternal deaths reported to the MMC due to hypertensive disease in pregnancy in the Netherlands during the years 2000-04.
  
  
  METHODS
  Assessment for substandard care factors using a checklist based on the Dutch guideline of 'Hypertensive Disorders in Pregnancy'.
  
  
  METHODS
  Substandard care in cases of maternal mortality due to hypertensive diseases in pregnancy.
  
  
  RESULTS
  A total of 27 cases of maternal death due to hypertensive disease in pregnancy were reported to the committee in the study period. In 26 cases (96%), substandard care factors were present, of which in 17 cases (63%), these were for more than five different items. In community midwifery care, the most frequent substandard care factor was no testing for proteinuria when clearly indicated (41%). In hospital care, the most frequent substandard care was related to insufficient diagnostic testing when indicated (41%), insufficient management of hypertension by obstetricians (85%), no use or inadequate use of magnesium sulphate (67%), inadequate stabilisation before transport to tertiary care centres and/or delivery (52%) and failure to consider timely delivery (44%).
  
  
  CONCLUSIONS
  Education of pregnant women concerning danger signs of hypertensive disease should be improved. Training of midwives and obstetricians should be improved in the following areas: performing basic diagnostic tests, adequate management of hypertension and eclampsia, with more attention to treatment of systolic blood pressure. This training should be guided by clear local protocols. Delivery should not be delayed in serious cases of hypertensive disease in pregnancy, not only after 32-34 weeks but also in early-onset pre-eclampsia as maternal risks often outweigh possible fetal benefits of temporising management.
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands. jokeschutte@og.umcg.nl
authors.forename: J M
authors.initials: JM
authors.lastname: Schutte
authors.forename: N W E
authors.initials: NW
authors.lastname: Schuitemaker
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: E A P
authors.initials: EA
authors.lastname: Steegers
mesh_terms: D000328:Adult; D003152:Community Health Nursing / Q000592:standards; D005260:Female; D006760:Hospitalization; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality* / Q000628:therapy; D020300:Intracranial Hemorrhages / Q000401:mortality; D008428:Maternal Mortality; D008880:Midwifery / Q000592:standards; D009426:Netherlands / Q000453:epidemiology; D010353:Patient Education as Topic; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care / Q000592:standards*; D011787:Quality of Health Care