title: Incidence and predictors of maternal cardiovascular mortality and severe morbidity in The Netherlands: a prospective cohort study.
abstract: OBJECTIVE
  To assess incidence and possible risk factors of severe maternal morbidity and mortality from cardiovascular disease in The Netherlands.
  
  
  METHODS
  A prospective population based cohort study.
  
  
  METHODS
  All 98 maternity units in The Netherlands.
  
  
  METHODS
  All women delivering in The Netherlands between August 2004 and August 2006 (n = 371,021).
  
  
  METHODS
  Cases of severe maternal morbidity and mortality from cardiovascular disease were prospectively collected during a two-year period in The Netherlands. Women with cardiovascular complications during pregnancy or postpartum who were admitted to the ward, intensive care or coronary care unit were included. Cardiovascular morbidity was defined as cardiomyopathy, valvular disease, ischaemic heart disease, arrhythmias or aortic dissection. All women delivering in the same period served as a reference cohort.
  
  
  METHODS
  Incidence, case fatality rates and possible risk factors.
  
  
  RESULTS
  Incidence of severe maternal morbidity due to cardiovascular disease was 2.3 per 10,000 deliveries (84/358,874). Maternal mortality rate from cardiovascular disease was 3.0 per 100,000 deliveries (11/358,874). Case fatality rate in women with severe maternal morbidity due to cardiovascular disease was 13% (11/84). Case fatality rate was highest in aortic dissection (83%). Pre-existing acquired or congenital heart disease was identified in 34% of women. Thirty-one percent of women were of advanced maternal age (>35 years of age) and 5 percent above 40 years of age. Possible risk factors for cardiovascular morbidity were caesarean section (either resulting in or as a result of cardiovascular disease), multiple pregnancy, prior caesarean section, non-Western ethnicity and obesity.
  
  
  CONCLUSIONS
  In The Netherlands cardiovascular disease is a rare cause of severe maternal morbidity with an incidence of 2.3 per 10,000 deliveries and a high case fatality rate of 13%. Cardiovascular complications develop mostly in women not known with cardiac disease pre-pregnancy.
authors: Department of Obstetrics and Gynaecology, Bronovo Hospital, The Hague, The Netherlands. c.m.a.huisman@gmail.com
authors: Claartje M
authors: CM
authors: Huisman
authors: Joost J
authors: JJ
authors: Zwart
authors: Jolien W
authors: JW
authors: Roos-Hesselink
authors: Johannes J
authors: JJ
authors: Duvekot
authors: Jos
authors: J
authors: van Roosmalen
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000401:mortality; D009202:Cardiomyopathies / Q000453:epidemiology / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D009017:Morbidity; D009035:Mothers / Q000706:statistics & numerical data*; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors