maternal mortality rate italy

Negandhi PH, Neogi SB, Chopra S, Phogat A, Sahota R, Gupta R, Gupta R, Zodpey S. Bull World Health Organ. Accurate estimates and reliable classification of maternal deaths are imperative steps in the chain of actions targeted at reducing avoidable maternal mortality. Record linkage procedures between routine statistics are a valuable resource for estimating MMR: an imperative step in the chain of actions aimed at preventing avoidable maternal deaths.22 The study results confirm the underestimation of the MMR computed through death certificates alone showing that 6 out of 10 maternal deaths went undetected in 10 Italian regions covering 77% of total births. The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19). Considerable regional differences in the provision of health services and health service information systems exist throughout the country.21. Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. Obstet Gynecol. Further, it analyses the role of the linkage between routine statistics in the maternal mortality reporting and its contribution to the prevention of maternal deaths. Setting: The theme‐based approach to maternal deaths classification is grounded on the evidence that the identification of the specific causes of death is crucial in setting up health priorities and prevention strategies. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. When needed, previous hospital discharge records have been retrieved and analyzed to clarify the cause of death. Maternal deaths were attributed to the region where the death occurred, regardless of the region of residence. Please check your email for instructions on resetting your password. Eur J Obstet Gynecol Reprod Biol. Data from a 7‐year period between 2006 and 2012 has been reported in all regions except Apulia, where deaths register were available only for the years 2004‐2010. This paper updates and extends the record‐linkage analysis of maternal mortality to 10 Italian regions and presents the strengths and limitations of different approaches to maternal death classification. Blood Transfus. Objective: The annual maternal mortality rate (MMR) was 26.7 per 100,000 live births in the period 1978-1987 and declined significantly to 10.9 per 100,000 live births in the period 1997-2010. Objective: To establish the extent of maternal mortality in Italy in between 1980 and 1996 in order to compare it with the international data.Study Design: We conducted a retrospective study on maternal deaths in Italy from 1980 to 1996.Data have been collected by Italian Statistic Institute (ISTAT). The higher MMR detected among less educated women is consistent with international evidence.27. PIP: In Italy, maternal mortality declined from 133.3/100,000 live births in 1955 to 11.4/100,000 live births in 1984, a reduction of approximately 90%. Salvatore Alberico, Antonello Antonelli, Simona Asole, Vittorio Basevi, Irene Cetin, Paolo Chiodini, Gabriella Dardanoni, Domenico Di Lallo, Valeria Dubini, Cinzia Germinario, Manuela Giangreco, Lisa Gnaulati, Giuseppe Loverro, Camilla Lupi, Pasquale Martinelli, Arianna Mazzone, Luca Merlino, Alessandra Meloni, Lorenzo Monasta, Luisa Mondo, Davide Parisi, Marcello Pezzella, Arianna Polo, Monia Puglia, Raffaella Rusciani, Immacolata Schimmenti, Pierluigi Sozzi, Daniela Spettoli, Fabio Voller. Linking disease registries and nationwide healthcare administrative databases: the French renal epidemiology and information network (REIN) insight. [Epidemiology of maternal mortality in France, 2010‐2012, Maternal mortality as indicator of obstetric care in Europe, Emorragia post partum: come prevenirla, come curarla. Main outcome measure: Italy maternal mortality rate for 2016 was 2.00 , a 0% increase from 2015. Maternal mortality rates tend to be higher where women have more children. This finding is in line with what was observed in other high‐income countries12, 18 and could be explained by both higher maternal age at birth and improvements in the cardiac care that increased the survival of affected women. To detect maternal deaths, analyse associated causes and compute absolute and specific maternal mortality ratio among five Italian regions in response to a recent ranking of Italy by the Lancet as having the lowest maternal mortality ratio among 181 countries. Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. We are grateful to Silvia Andreozzi for her valuable technical assistance and Gianpaolo Coscia and Claudia Ferraro for the English language revision. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India. 2009 Feb;142(2):124-8. doi: 10.1016/j.ejogrb.2008.10.009. Epub 2019 Sep 12. In order of frequency follow road accidents (9.6%), cardiac deaths (8.9%) and neurological deaths (3.9%). The data are estimated with a regression model using information on fertility, birth attendants, and HIV prevalence. 2020 Jan;18(1):13-19. doi: 10.2450/2019.0060-19. Pulmonary embolism associated with transfusion after severe post-partum haemorrhage: is less more? The Journal of Maternal-Fetal & Neonatal Medicine.  |  Epub 2012 Nov 19. Kubota C, Inada T, Shiino T, Ando M, Sato M, Nakamura Y, Yamauchi A, Morikawa M, Okada T, Ohara M, Aleksic B, Murase S, Goto S, Kanai A, Ozaki N. Front Psychiatry. During 2006‐2012, a maternal mortality ratio of 9.8 maternal deaths/100 000 live births was estimated in 10 Italian regions covering 77% of the national births. USA.gov. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020181497. DEFINITION: Maternal mortality reported per 100,000 births 1985-1999. Different time periods were analysed according to local data availability. The preterm birth rate of 20% and the cesarean delivery rate exceeding 80% seems related to geographic practice patterns. The maternal mortality rate (MMR) has decreased by almost half within the European Region between 2000 to 2015, from 33 to 16 deaths per 100 000 live births respectively. As the graph below shows, over the past 58 years this indicator reached a maximum value of 44.20 in 1960 and a minimum value of 2.60 in 2018. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. The majority (38.8%) were caused by malignant neoplasms. These results therefore refer to the 10 participating regions, covering 77% of the total births in Italy. MMR, maternal mortality ratio; DMMR, direct maternal mortality ratio; CI, confidence interval. Deaths during and within 1 year after pregnancy have been identified through linkage between death registry and hospital discharge database. Mortality rate in Italy in 2015: an increase of 9.1% to be explained On 19th February 2016 the Italian National Institute of Statistics (ISTAT) released 2015 mortality data reporting 9.1% excess mortality as compared to 2014, this corresponding to 54,000 excess deaths and representing the highest reported mortality rate (10.7 per 1000) since World War 2 (1). We included in the violent deaths also 22 deaths by homicide, that are usually classified as coincidental and neglected by maternal mortality analysis. This is an important observation in a country with one of the highest rates of cesarean section (36.3% in 2013)20 in Europe and explains the need for prospective surveillance through incident case reporting. Conversely, the issue needs to be clearly pointed out because pregnancy and the puerperium represent periods of higher risk of domestic abuse leading to homicide.30 Homicide as well as suicide are important and potentially preventable causes of deaths within 1 year postnatally.18. 4. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … A total of 118 maternal deaths have been identified resulting in a maternal mortality ratio of 11.8, compared with the official figure of 4.4, per 100,000 live births. . Maternal mortality is a key indicator of women's reproductive health status and of the appropriateness of obstetric care in a country. Maternal death rate helps to rate the hospital. Violent deaths ranked second, represented by 10.0% of suicides, 3.7% of homicides and 2.0% of other not specified violent causes of death. In the visualization we see estimates of the share of women that will die from maternal causes in their lifetime, for the country averages. Countries by maternal mortality ratio. Epub 2012 Feb 22. The MMR has been estimated and deaths were classified as direct or indirect and according to their primary causes. Excluding coincidental causes, 277 maternal deaths have been counted, of which 13 have been retrieved by the national linkage. Eight percent of late deaths were from unidentified causes. Trade in Value Added (December 2018) Health Status. Among deaths within 42 days after pregnancy, cardiac disease stands as the main non‐obstetric cause of death. Epub 2008 Dec 5. Twenty‐three cases of early pregnancy deaths were detected (MMR 0.76), most due to cardiac disease (n = 5) and malignancy (n = 4). Abstract. Epub 2016 May 2. 2013 Jan;108(1):38-49. doi: 10.1111/add.12010. Underreporting of pregnancy-related mortality in the United States and Europe. The national record linkage procedure was used for the identification of women who died in the participating regions but who were resident or hospitalized somewhere else. All suggestions for corrections of any errors about Maternal mortality rate should be addressed to the CIA. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population‐based study. Read also the comment (in Italian) by the ItOSS working gro PRE‐C318/15, Rome 12/05/2015). An accurate estimate of the maternal mortality ratio (MMR), as well as a reliable identification and classification of the causes of maternal death, is still a complex challenge worldwide.1-3, Reporting MMR based on death registers alone fails to detect the overall magnitude of the phenomenon, even where complete vital registration systems are in place.4, 5 Among high income countries, some estimate the MMR only through mortality registers, whereas others adopt record linkage procedures between routine statistics.6-8 In addition, a minority of countries rely on maternal mortality surveillance systems, that include confidential death enquiries9, 10 or multiple sources of death identification and a confidential review in order to document and classify maternal deaths.11, 12, It is widely recognized that the classification of maternal deaths into direct obstetric deaths and indirect non‐obstetric deaths, first published in 1975 and further detailed in 2012,13 enabled a focus on the need for improvement of the quality of obstetric care and contributed to the reduction of deaths from obstetric complications worldwide.14 The increase in indirect maternal deaths, however, particularly in high‐income countries, raised some doubts about the usefulness of maintaining this distinction.3 A theme‐based approach to maternal death classification consisting of grouping maternal deaths according to the causes, has been proposed. Almost all maternal deaths (99%) occur in developing countries. The EPMM target for reducing the global maternal mortality ratio (MMR) by 2030 was adopted as Sustainable Development Goal target 3.1: to reduce global MMR to less than 70 per 100 000 live births by 2030. In the present study the proportion of unclassifiable maternal deaths within 42 days is much lower (9%) than that (23%) reported in the years 2000‐2007.6 The possible interpretations of this important reduction calls into question the greater coding accuracy and the use of the previous hospital discharge records to clear undefined causes of death. As recently proposed by several researchers across Europe,3, 12, 18 we also analyzed our data highlighting the causes of death. COVID-19 is an emerging, rapidly evolving situation. Methods: No claims are made regarding the accuracy of Maternal mortality rate information contained here. National death certificates and hospital discharge database have also been used to perform the same record‐linkage procedure described for the regional protocol. Hemorrhage was the main cause of death. The MMR was calculated as the number of deaths during pregnancy or within 42 days from any pregnancy outcome every 100 000 live births, within the same region and time period. Italy has about 60.5 million inhabitants to date, and more than 470 000 live births per year.20 The National Health Service provides free comprehensive coverage to the entire population and responsibility for healthcare is shared by the central government and the 20 Italian regions. Please enable it to take advantage of the complete set of features! Epub 2015 May 10. 2020 May 15;11:441. doi: 10.3389/fpsyt.2020.00441.  |  Sadly, about 700 women die each year in the United States as a result of pregnancy or delivery complications. In 2017, maternal mortality ratio for Italy was 2 deaths per 100,000 live births. Pregnancy-associated deaths in Finland 1987-1994--definition problems and benefits of record linkage. The indirect mortality ratio was 3.38 per 100 000 live births, higher in the northern compared to the central, southern and insular regions. A pilot study using record linkage procedure between regional routine statistics has been conducted in five Italian Regions covering 39% of total live births within the country between 2000 and 2007.6 The procedure estimated a MMR of 11.8 maternal deaths per 100 000 live births and identified a 63% underestimation of the officially published MMR based on death register alone. Cases have been selected and causes of death have been classified according to the 10th International Classification of Diseases. Italy maternal mortality rate for 2015 was 2.00 , a 0% increase from 2014. We point out that 35% of Italian women who deliver are aged ≥35 years and that interventions for labor and delivery management at potentially greater risk of postpartum hemorrhage are frequent (eg 40% of episiotomies and 35% of cesarean section).20 Previous studies showed that many of these deaths are preventable, to the point that the ratio of maternal deaths attributed to hemorrhage has been proposed as an indicator of appropriateness of obstetric care in emergency.18, 25 The specific MMR for obstetric hemorrhage decreased from 2.9 per 100 000 live births in the years 2000‐20076 to 1.92 in 2006‐2012 (P‐value = .0695). Five Italian regions. Maternal death is the death of a woman while she is pregnant or within 42 days of termination of pregnancy. Perinatal mental health around the world: priorities for research and service development in Italy. Definition: The maternal mortality ratio (MMRatio) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). According to the theme‐based approach obstetric hemorrhage was the major cause of death within 42 days from the pregnancy outcome (Figure 1) (58 cases, specific MMR 1.92) followed by hypertensive disorders (32 cases, specific MMR 1.06) of pregnancy and cardiac diseases (32 cases, specific MMR 1.06). 2017 Nov 13;5:2050312117740490. doi: 10.1177/2050312117740490. In addition, they support the view that both the indirect/direct deaths and the classification by cause have a role in countries where direct deaths still exceed indirect and where wide interregional differences in the health care are in place. Statistics for mother's educational level show a ratio significantly higher among women with 8 or less years of education (MMR 16.36). Due to 20% missed links between the national data sources, a national MMR has not been estimated. The under‐reporting rate of official MMR figures in the participating regions is 60.3%. By a deterministic linkage procedure, women's nominal data were matched to pregnancy or pregnancy‐related hospitalizations (spontaneous abortion, induced abortion, ectopic pregnancy, stillbirth or live births). The ratio was significantly higher amongst women aged ≥40 years (MMR 27.04) and Asian women (MMR 22.87), half of which were Chinese. Underreporting of official figures based on death certification in the participating regions is 63%. Background: Infant mortality rate (IMR) is used as a population health indicator. Our analysis shows a predominance of direct obstetric deaths, which implies that emphasis is needed on improvements of obstetric care. Consumer price indices - inflation. Chart and table of the Italy infant mortality rate from 1950 to 2021. Source: Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at www.… Acta Obstet Gynecol Scand. In 2013, Italy introduced an enhanced system that combines record‐linkage analysis with audits on maternal deaths and a confidential enquiry system to document and classify all incident cases, thus increasing the likelihood of preventing avoidable maternal deaths. Maternal deaths have been identified by record linkage between the Death Registry and the Hospital Discharge Database. Every woman resident or living in the participating regions at the time of death and discharged from any public or private hospital for pregnancy or any pregnancy outcome was included in the study. Would you like email updates of new search results? Our findings reaffirm the limits of generic algorithms for correction of maternal mortality misclassification previously reported.19, 23 Despite this, the MMR of 9.8 per 100 000 live births, places Italy amongst the 28 countries with the lowest MMR globally.17 The large variability of the MMR by geographical area is probably related to the regional socioeconomic and health care imbalances characterizing Italy, with the South holding lower life expectancy and higher perinatal and infant mortality rates.20. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, Causes of death between 43 and 365 d after the end of pregnancy, By continuing to browse this site, you agree to its use of cookies as described in our, BJOG: An International Journal of Obstetrics & Gynaecology, International Journal of Gynecology & Obstetrics, Acta Obstetricia et Gynecologica Scandinavica, Australian and New Zealand Journal of Obstetrics and Gynaecology, Journal of Obstetrics and Gynaecology Research, orcid.org/http://orcid.org/0000-0003-4754-5385, The Regional Maternal Mortality Working Group, I have read and accept the Wiley Online Library Terms and Conditions of Use, Global, regional, and national levels and causes of maternal mortality during 1990‐2013: a systematic analysis for the Global Burden of Disease Study 2013, Methods to estimate maternal mortality: a global perspective, Maternal mortality: direct or indirect has become irrelevant, Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality, Underreporting of pregnancy‐related mortality in the United States and Europe, Maternal mortality in Italy: a record linkage study, Pregnancy related deaths in four regions of Europe and the United States in 1999‐2000: characterisation of unreported deaths, Maternal mortality in Sweden 1988‐2007: more deaths than officially reported, Saving Mothers’ Lives: the continuing benefits for maternal health from the United Kingdom (UK) Confidential Enquires into Maternal Deaths, Confidential enquiry into maternal deaths in The Netherlands 1983‐1992, California pregnancy‐associated mortality review: mixed methods approach for improved case identification, cause of death analyses and translation of findings, The WHO application of ICD‐10 to deaths during pregnancy, childbirth and puerperium: ICD MM, What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries, The impact of reclassifying suicides in pregnancy and postnatal period on maternal mortality ratios, Late maternal deaths: a neglected responsibility, GBD 2015 Maternal Mortality Collaborators, Global, regional, and national levels of maternal mortality, 1990‐2015: a systematic analysis for the Global Burden of Disease Study 2015, Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2011‐13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009‐13, Popolazione e famiglie [Population and families]. Population:  |  Our goal is to produce a national estimate of maternal mortality involving the remaining regions. These regions were selected by annual number of births (≥35 000), adequate period of data availability (≥3 years) and were balanced for number of births by geographic area to avoid distortions in the MMR estimate. 2012 Apr;91(4):452-7. doi: 10.1111/j.1600-0412.2012.01352.x. Gross domestic product (annual) Gross domestic product (quarterly) Composite Leading Indicators. Six out of 10 of these deaths were unrecognized by the official figures. HHS Maternal mortality ratio (national estimate, per 100,000 live births) - Italy The country data compiled, adjusted and used in the estimation model by the Maternal Mortality Estimation Inter-Agency Group ( … (StataCorp., College Station, TX, USA). Regional death certificates of women aged 11‐59 years who died in 10 Italian regions located in northern (Piedmont, Lombardy, Friuli Venezia Giulia, Emilia‐Romagna), central (Tuscany, Latium) and southern and insular (Campania, Apulia, Sicily, Sardinia) Italy have been selected. The national record‐linkage procedure has allowed adding 29 cases escaped to the regional procedure because the deceased women were not resident or not hospitalized in the region of death. Suicides have been classified as indirect deaths because the record linkage procedure does not distinguish those occurring in women with previous psychiatric disorders—classifiable as indirect deaths and first by frequency according to the literature—from those related to postpartum psychosis that could be classified as direct deaths according to the ICD‐MM (World Health Organization Application of ICD‐10 to deaths during pregnancy, childbirth and the puerperium).13 Deaths resulting from road or other accidents, assault or rape were classified as coincidental. Definitions and data sources [Postpartum hemorrhage: prevention and management] (in Italian). (in Italian. Grandone E, Colaizzo D, Mastroianno M, Petruzzelli F, di Mauro L, Carella M, Tiscia GL, Ostuni A. eCollection 2020. Number of times cited according to CrossRef: A multifaceted approach towards investigating childbirth deaths in double burials: Anthropology, paleopathology and ancient DNA. Acta Obstetricia et Gynecologica Scandinavica. This was conducted using the tax identification number instead of nominal data which were not available for privacy reasons. Design: Regional and national data sources from 2006 to 2012 were used. Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. Regional maternal mortality working group. During 2006-2012, a maternal mortality ratio of 9.8 mater - nal deaths/100000 live births was estimated in 10 Italian regions covering 77% of the national births. Among the maternal deaths identified by the record‐linkage procedure, any woman who died within 365 days from any pregnancy outcome (ie, abortion, ectopic pregnancy, births) has been selected. MMR by women's socio‐demographic characteristics demonstrated an expected increase in pregnancy related mortality among older women, that is more than three‐fold higher among women aged ≥40 (Table 3). 2016 May 1;94(5):370-5. doi: 10.2471/BLT.15.157693. eCollection 2017. With this limitation in mind, our findings add accurate, updated and wider information to the current knowledge on maternal mortality in Italy. This implies a growing commitment for the Italian health system since the mean age of women at first birth is the highest in Europe and the proportion of women delivering ≥35 years increased from 9% in 1981 to 35% in 2014.20 The excess in mortality among Chinese women residing in Italy could be a symptom of a more difficult access to care compared both to Italian and other migrant women. ... Maternal and infant mortality Customise. This site needs JavaScript to work properly. Record‐linkage is an efficient and reliable method to estimate maternal mortality and to identify causes of maternal deaths. Record-linkage study. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Analysis of Patients Undergoing Peripartum Hysterectomy for Obstetric Causes According to Delivery Methods: 13-Year Experience of a Tertiary Center. Maternal mortality rose with age and was about tenfold higher in the highest risk group (greater than or equal to 40 years old) compared with the lowest risk group (less than 20 years old). Cesarean delivery rate exceeding 80 % seems related to geographic practice patterns Savigny D, Mikkelsen L, PW... ; regional maternal mortality ratio is the number of women who die during pregnancy within! Hysterectomy for obstetric causes according to their primary causes after the end of pregnancy are leading. 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In Value Added ( December 2018 ) health Status was calculated considering only direct.! Birth attendants, and several other advanced features are temporarily unavailable perform same! Key indicator of women 's characteristics are presented in ( Table 2:124-8.. In Value Added ( December 2018 ) health Status Nichols E, Notzon F, Lopez AD days the... Underreporting of official figures a woman while she is pregnant or within days. Three main causes of death and of the appropriateness of obstetric care in a country appropriateness of obstetric care 80... Statistical Package Stata/IC 14.2 pregnancy outcome cardiac Disease stands as the main non‐obstetric cause of death, a! To local data availability ratio ; DMMR, direct maternal mortality is a key of! Please enable it to take advantage of the last woman 's hospital admission pregnancy.

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