title: Maternal mortality in Sweden 1988-2007: more deaths than officially reported.
abstract: OBJECTIVE
  To obtain more accurate calculations of maternal and pregnancy-related mortality ratios in Sweden from 1988 to 2007 by using information from national registers and death certificates.
  
  
  METHODS
  A national register-based study, supplemented by a review of death certificates.
  
  
  METHODS
  Sweden, 1988-2007.
  
  
  METHODS
  The deaths of 27 957 women of reproductive age (15-49 years).
  
  
  METHODS
  The Swedish Cause of Death Register, Medical Birth Register, and National Patient Register were linked. All women with a diagnosis related to pregnancy in at least one of these registers within 1 year prior to death were identified. Death certificates were reviewed to ascertain maternal deaths. Maternal mortality ratio (the number of maternal deaths/100 000 live births, excluding and including suicides), and pregnancy-related mortality ratio (number of deaths within 42 days after termination of pregnancy, irrespective of cause of death/100 000 live births) were calculated.
  
  
  METHODS
  Direct and indirect maternal deaths and pregnancy-related deaths.
  
  
  RESULTS
  The maternal mortality ratio in Sweden, based on the current method of identifying maternal deaths, was 3.6. After linking registers and reviewing death certificates, we identified 64% more maternal deaths, resulting in a ratio of 6.0 (or 6.5 if suicides are included). The pregnancy-related mortality ratio was 7.3. A total of 478 women died within a year after being recorded with a diagnosis related to pregnancy.
  
  
  CONCLUSIONS
  By including the 123 cases of maternal death identified in this study, the mean maternal mortality ratio from 1988 to 2007 was 64% higher than reported to the World Health Organization.
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden. annika.esscher@kbh.uu.se
authors.forename: Annika
authors.initials: A
authors.lastname: Esscher
authors.forename: Ulf
authors.initials: U
authors.lastname: Högberg
authors.forename: Bengt
authors.initials: B
authors.lastname: Haglund
authors.forename: Birgitta
authors.initials: B
authors.lastname: Essën
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011253:Pregnancy in Adolescence; D012042:Registries; D013548:Sweden / Q000453:epidemiology