title: Maternal deaths in Iceland over 25 years.
abstract: BACKGROUND
  Maternal death, during pregnancy or within 42 and 365 days from the end of pregnancy, was evaluated for a small high-income nation with comprehensive healthcare.
  
  
  METHODS
  Cases were identified using record linkage by running national census information on all deaths of women aged 15-49 years during 1985-2009 against the national birth register and computerized hospital admission files for pregnancy-related diagnoses as well as actual case records where needed. Death certificates and hospital records were reviewed.
  
  
  RESULTS
  Thirty deaths were identified; 26 at ≥ 22 weeks (= birth) and four earlier in pregnancy. For 107,871 deliveries, the overall mortality was 27.8/100,000. There were five direct deaths (4.6/100,000 deliveries), five indirect deaths (4.6/100,000 deliveries) and 19 coincidental deaths (17.6/100,000 deliveries). Using WHO criteria (direct and indirect in pregnancy or at ≤ 42 days postpartum) the ratio was 5.6/100,000 deliveries (95% confidence interval 1.1-10.1) and 5.5/100,000 live births (maternal mortality ratio, based on six deaths). Direct deaths were caused by sepsis, severe preeclampsia and choriocarcinoma, indirect by suicide, pre-existing cardiac and diabetic illness. No woman died of postpartum hemorrhage, anesthesia or ectopic pregnancy. Suboptimal care occurred.
  
  
  CONCLUSIONS
  Maternal mortality in Iceland over a 25-year period up to the end of year 2010 was low, between 5 and 6/100,000 births. A comprehensive national healthcare system with accessible antenatal care in a society with good general living conditions and universal education probably contributed to this.
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
authors.forename: Hera
authors.identifier: http://orcid.org/0000-0002-7012-4688
authors.initials: H
authors.lastname: Birgisdottir
authors.affiliation: Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavík, Iceland.
authors.forename: Ragnheidur I
authors.identifier: http://orcid.org/0000-0003-0503-1319
authors.initials: RI
authors.lastname: Bjarnadottir
authors.affiliation: Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavík, Iceland.
authors.forename: Katrin
authors.identifier: http://orcid.org/0000-0002-1041-2039
authors.initials: K
authors.lastname: Kristjansdottir
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavík, Iceland.|Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavík, Iceland.
authors.forename: Reynir T
authors.identifier: http://orcid.org/0000-0002-5419-0909
authors.initials: RT
authors.lastname: Geirsson
mesh_terms: D000059:Accidents / Q000401:mortality; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002822:Choriocarcinoma / Q000150:complications / Q000401:mortality*; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D050498:Live Birth / Q000453:epidemiology; D063130:Maternal Death / Q000209:etiology; D008428:Maternal Mortality; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality; D011251:Pregnancy Complications, Infectious / Q000401:mortality*; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality*; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D013405:Suicide / Q000706:statistics & numerical data; D014594:Uterine Neoplasms / Q000150:complications / Q000401:mortality*; D055815:Young Adult
keywords: Maternal death; birth registration; maternal morbidity; perinatal care; serious adverse events; women's health issues