Maternal deaths in Norway 2005-2009.
BACKGROUND
Norway has low maternal mortality, but such deaths are underreported even in high-income countries. Our goal was to identify the exact number of maternal deaths, the causes of death and the potential for improvement through medical care in Norway.


METHODS
We traced maternal deaths in the period from 1 January 2005 to 31 December 2009 by linking the Medical Birth Registry and the Cause of Death Registry, supplemented with data from maternity clinics. We identified the cause of death and the lessons that could be learned by a meticulous review of each case.


RESULTS
We found 26 maternal deaths during the period, 14 of which were due to direct causes and 12 to indirect causes. The maternal mortality ratio was 8.7/100,000 live births. Fourteen of the deaths were registered in official statistics. Of the 12 deaths that were not included in the statistics, 11 were found through matching the registers and one had been reported directly by the hospital. The most common causes of death were hypertensive disorders during pregnancy (n = 6), thromboembolism (n = 4) and mental illness (n = 4). None of the deaths due to thromboembolism appeared in official statistics. The same applied to nine of the 12 indirect maternal deaths. We found a potential for improved medical care in 14 of 26 cases. Half of these were deaths due to hypertensive disorders during pregnancy or thromboembolism.


CONCLUSIONS
Maternal death was considerably underreported in Norwegian official statistics during the period studied. Greater attention should be given to better blood-pressure treatment, stabilisation and timely delivery in the case of hypertension during pregnancy, and to screening for possible pulmonary embolism. The same applies to mental illness and internal medical disorders in pregnant women.
Nasjonal kompetansetjeneste for kvinnehelse Oslo universitetssykehus og Avdeling for folkesykdommer Nasjonalt folkehelseinstitutt.
Siri
S
Vangen
Fødeavdelingen Oslo universitetssykehus, Rikshospitalet.
Liv
L
Ellingsen
Helse Sør-Øst RHF.
Alice Beathe
AB
Andersgaard
Fødeavdelingen Oslo universitetssykehus, Ullevål.
Anne Flem
AF
Jacobsen
Fødeavdelingen, Oslo universitetssykehus, Rikshospitalet.
Bjørg
B
Lorentzen
Kvinneklinikken Vestre Viken, Drammen.
Lill Trine
LT
Nyfløt
Kvinneklinikken Stavanger universitetssjukehus.
Astrid Betten
AB
Rygh
Kvinneklinikken Haukeland universitetssykehus.
Svein Magne
SM
Skulstad
Kvinneklinikken St. Olavs hospital.
Christian
C
Tappert
Kvinneklinikken Universitetssykehuset Nord-Norge.
Pål
P
Øian
D002423:Cause of Death; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008428:Maternal Mortality; D001523:Mental Disorders / Q000401:mortality; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D012042:Registries; D013923:Thromboembolism / Q000401:mortality