[Postpartum hemorrhage: prevention and management] (in Italian). Read also the comment (in Italian) by the ItOSS working gro USA.gov. 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. The current infant mortality rate for Italy in 2021 is 2.350 deaths per 1000 live births, a 3.45% decline from 2020.; The infant mortality rate for Italy in 2020 was 2.434 deaths per 1000 live births, a 3.3% decline from 2019. The under‐reporting rate of official MMR figures in the participating regions is 60.3%. eCollection 2020. Monetary conversion rates. 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). 2015 Oct 3;386(10001):1373-1385. doi: 10.1016/S0140-6736(15)60173-8. Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. Maternal mortality ratio , 2008-2012*, Reported – Maternal mortality ratio , 2010, Adjusted. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … Sadly, about 700 women die each year in the United States as a result of pregnancy or delivery complications. The maternal deaths identified through the regional and national procedures were compared to validate their correspondence. Working off-campus? 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. The Risk Factors Predicting Suicidal Ideation Among Perinatal Women in Japan. Conclusions: Background: Infant mortality rate (IMR) is used as a population health indicator. 2017 Nov 13;5:2050312117740490. doi: 10.1177/2050312117740490. Direct maternal mortality ratio was calculated considering only direct deaths. Epub 2019 Sep 12. Related Pages. The data were analyzed using the Statistical Package Stata/IC 14.2. Maternal deaths were attributed to the region where the death occurred, regardless of the region of residence. Gross domestic product (annual) Gross domestic product (quarterly) Composite Leading Indicators. eCollection 2017. The attribution of the type and cause of death has been performed at regional level and revised by a group of experts at the Italian National Health Institute. Lancet. The indirect mortality ratio was 3.38 per 100 000 live births, higher in the northern compared to the central, southern and insular regions. Our goal is to produce a national estimate of maternal mortality involving the remaining regions. 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. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) Six out of 10 of these deaths were unrecognized by the official figures. Main outcome measure: 1997 Aug;76(7):651-7. doi: 10.3109/00016349709024605. MMR, maternal mortality ratio; DMMR, direct maternal mortality ratio; CI, confidence interval. Due to 20% missed links between the national data sources, a national MMR has not been estimated. In Italy obstetric hemorrhage ranks first among causes of maternal death, followed by hypertensive disorders during pregnancy. Italian Ministry of Health. 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. 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. 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 ratio. Donati S, Senatore S, Ronconi A; Regional Maternal Mortality Working Group. Maternal death rate helps to rate the hospital. Monitoring severe acute maternal morbidity across Europe: A feasibility study. 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. Hemorrhage was the main cause of death. 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. Direct (54%) exceed indirect deaths (37%), with the geographical variability mentioned above, highlighting that emphasis on obstetric care improvement is urgently needed, especially in the South of the country. Record‐linkage is an efficient and reliable method to estimate maternal mortality and to identify causes of maternal deaths.  |  The latter seems to be the best way to understand the risk factors and the outcomes of pre‐existing medical and mental health disorders during pregnancy and to guide efforts to improve tailored care for complex conditions.3, 15, The lack of awareness about late maternal mortality—occurring from 43 to 365 days after childbirth—has been identified as a further factor leading to fragmented care and missed opportunities during pregnancy or after delivery.16 Therefore, its inclusion in the maternal mortality analysis has been claimed at different levels.13, 17 Indeed, the 2015 MBRRACE‐UK report (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), that first included information on late maternal deaths gathered through the linkage of adult female deaths and birth information, increased by over 50% the numbers of late deaths compared to those identified through the confidential enquiries.18. With data from early in the pandemic, it is reassuring that there are low rates of maternal and neonatal mortality and vertical transmission with SARS-CoV-2. 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. 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. NOTE: The information regarding Maternal mortality rate on this page is re-published from the CIA World Factbook 2019. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020181497. Our analysis shows a predominance of direct obstetric deaths, which implies that emphasis is needed on improvements of obstetric care. Perinatal mental health around the world: priorities for research and service development in Italy. 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. Please check your email for instructions on resetting your password. 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). 2009 Feb;142(2):124-8. doi: 10.1016/j.ejogrb.2008.10.009. 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. The aims of this study were to estimate the maternal mortality ratio (MMR) in 10 Italian regions covering 77% of total national births and to identify the most suitable approach to classify the causes of death. Among deaths within 42 days after pregnancy, cardiac disease stands as the main non‐obstetric cause of death. Statistics for mother's educational level show a ratio significantly higher among women with 8 or less years of education (MMR 16.36). Eight percent of late deaths were from unidentified causes. Affiliations. 2005 Oct;106(4):684-92. doi: 10.1097/01.AOG.0000174580.24281.e6. Regional and national data sources from 2006 to 2012 were used. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population‐based study. 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. 2.0 (deaths per 100,000 live births) in 2017. This was conducted using the tax identification number instead of nominal data which were not available for privacy reasons. Deneux-Tharaux C, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. Obstet Gynecol. The funders have no responsibility for the information or opinions contained in this paper. Maternal death or maternal mortality is defined by the World Health Organization (WHO) as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." 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. This site needs JavaScript to work properly. Statistics Service, Italian National Institute of Health‐Istituto Superiore di Sanità, Rome, Italy. Download the “First ItOSS report.Maternal mortality surveillance” (pdf 2.8 Mb, in Italian) and the corrigenda (pdf 149 kb, in Italian), which update the list of experts of the Committee for Confidential Enquiries of region Tuscany, and the list of coordinators of birth facilities and the clinical risk network of region Tuscany. We included in the violent deaths also 22 deaths by homicide, that are usually classified as coincidental and neglected by maternal mortality analysis. Pregnancy-associated deaths in Finland 1987-1994--definition problems and benefits of record linkage. Population: Clipboard, Search History, and several other advanced features are temporarily unavailable. Learn more. The below online MMR Calculator helps you in the Maternal Mortality Rate Calculation using the number of direct maternal deaths and the number of maternal discharges (including deaths). Accurate estimates and reliable classification of maternal deaths are imperative steps in the chain of actions targeted at reducing avoidable maternal mortality. Regional maternal mortality working group. 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). Number of times cited according to CrossRef: A multifaceted approach towards investigating childbirth deaths in double burials: Anthropology, paleopathology and ancient DNA. 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. The higher MMR detected among less educated women is consistent with international evidence.27. The results of this study offer an original contribution from a southern European country to the research aimed at reducing preventable maternal mortality. The age-specific maternal mortality rates from 1958-1981 showed that age was a risk factor and that the rates were … Comparing this result with the MMR estimated through death certificates alone (3.5 per 100.000 live births) the underestimation rate was 60.3% in the 10 included regions, even though death certificates contain a dedicated pregnancy checkbox since 2002. 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. The value for Mortality rate, infant (per 1,000 live births) in Italy was 2.60 as of 2018. The direct maternal mortality ratio was 4.94 with differences among geographical areas ranging from 1.39 in Friuli Venezia Giulia to 7.00 in Campania (Table 1). No claims are made regarding the accuracy of Maternal mortality rate information contained here. When needed, previous hospital discharge records have been retrieved and analyzed to clarify the cause of death. The record linkage procedure is particularly suitable in identifying late maternal deaths and its application allowed to recognize suicide as one of the most common causes of death among women in the year following birth, in several high income countries.18, 28 Violent cause, of which suicides were 64%, was the second most common cause of late maternal deaths in our study. Source: Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division) at www.… Analysis of Patients Undergoing Peripartum Hysterectomy for Obstetric Causes According to Delivery Methods: 13-Year Experience of a Tertiary Center. Epub 2012 Nov 19. Consumer price indices - inflation. Nevertheless, the highest national maternal mortality rate in the Region is now estimated to be an appalling 25 times the lowest. According to the International Classification of Diseases and Related Health Problems‐10th Revision (ICD‐10) classification, selected cases have been classified as maternal death (occurring during pregnancy or within 42 days following the termination of pregnancy) and late maternal death (occurring from 43 to 365 days from termination of pregnancy). HHS Underreporting of official figures based on death certification in the participating regions is 63%. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. (in Italian. NLM Pulmonary embolism associated with transfusion after severe post-partum haemorrhage: is less more? Design: Maternal death is the death of a woman while she is pregnant or within 42 days of termination of pregnancy. Maternal mortality ratio , 2010, Lifetime risk of maternal death (1 in:) 20300. National Institute of Statistic (ISTAT) demographic balance for live births was used for MMR denominators computation. Results: In response to “missed opportunities and potentially misleading results in maternal mortality study”. 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).  |  Between 1955 and 1984 Italian maternal mortality steadily declined by about 90% (from 133.3 per 100,000 live-births in 1955 to 11.4 in 1984). Since 2012, the Italian Obstetric Surveillance System has promoted many initiatives to reduce maternal mortality related to obstetric hemorrhage, including: a population‐based study on acute maternal morbidity caused by severe hemorrhage, training courses aimed at physicians and midwives and a national guideline regarding prevention and treatment of post‐partum hemorrhage.26 We are therefore confident that these multiple initiatives may contribute to a further significant decrease in the specific MMR for obstetric hemorrhage. AbouZahr C, de Savigny D, Mikkelsen L, Setel PW, Lozano R, Nichols E, Notzon F, Lopez AD. Grandone E, Colaizzo D, Mastroianno M, Petruzzelli F, di Mauro L, Carella M, Tiscia GL, Ostuni A. Among the 118 maternal deaths, 51 (43%) were classified as direct with obstetric hemorrhage as the leading cause, 40 (34%) as indirect and 27 (23%) were of unknown cause and therefore not classifiable. A total of 277 maternal deaths within 42 days after pregnancy were identified: 149 direct, 102 indirect causes and 26 unclassified‐resulting in a MMR of 9.18 per 100 000 live births. 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. Alice Maraschini, National Center for Disease Prevention and Health Promotion, Italian National Institute of Health‐Istituto Superiore di Sanità, Rome, Italy. DEFINITION: Maternal mortality reported per 100,000 births 1985-1999. Excluding coincidental causes, 277 maternal deaths have been counted, of which 13 have been retrieved by the national linkage. 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). Definition: Infant mortality rate is the number of infants dying before reaching one year of age, per 1,000 live births in a given year. ... Maternal and infant mortality Customise. Eur J Obstet Gynecol Reprod Biol. ), The healthcare service in Italy: regional variability, The failure of United States maternal mortality reporting and its impact on women's lives. 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. 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. 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. Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014: a case note review study. Methods: Regional data on infant deaths and live births were available for France, Germany, England, Portugal (1999–2000), and Italy (1990–2001). Learn about our remote access options, National Center for Disease Prevention and Health Promotion, Rome, Italy. We provide an updated description of temporal and geographical trends of IMR in Italy. Definitions and data sources More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. During the study period a total of 320 women died during pregnancy or within 42 days from the pregnancy outcome. 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. Maternal Mortality. Fifteen women died due to thrombosis or thromboembolism (MMR 0.50) and 12 by suicide (MMR 0.40); 15% of deaths were from unidentified causes. Deaths during and within 1 year after pregnancy have been identified through linkage between death registry and hospital discharge database. United Nations projections are also included through the year 2100. Maternal mortality in Denmark, 1985-1994. Record-linkage study. 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). The opportunities offered by linkage procedures of routine data exhibited limitations: (i) information was not always sufficient to attribute the primary cause of death, (ii) information on the woman's health status before and during pregnancy was not available, (iii) critical aspects of care that can help in preventing and limiting avoidable negative outcomes were not identified. The maternal deaths that occurred between 43 and 365 days after the end of pregnancy (Figure 2) were 543. NIH Acta Obstet Gynecol Scand. Analysis of preventability of malignancy-related maternal death from the nationwide registration system of maternal deaths in Japan. Economic Outlook. Setting: 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. Hemorrhage was the main cause of death. SAGE Open Med. These results therefore refer to the 10 participating regions, covering 77% of the total births in Italy. COVID-19 is an emerging, rapidly evolving situation. The Journal of Maternal-Fetal & Neonatal Medicine. 4. The same proportion of maternal direct deaths was estimated in the Nordic countries between 2005 and 2013,12 whereas the UK and France reported lower percentages of direct deaths, respectively 37% and 47% in the years 2010‐2012.18, 24 Both countries initiated obstetric surveillance systems and interventions to reduce avoidable obstetric complications long before Italy. Civil registration and vital statistics: progress in the data revolution for counting and accountability.  |  Linking disease registries and nationwide healthcare administrative databases: the French renal epidemiology and information network (REIN) insight. Gissler M, Kauppila R, Meriläinen J, Toukomaa H, Hemminki E. Acta Obstet Gynecol Scand. 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. PRE‐C318/15, Rome 12/05/2015). Epub 2016 May 2. Blood Transfus. National death certificates and hospital discharge database have also been used to perform the same record‐linkage procedure described for the regional protocol. Chart and table of the Italy infant mortality rate from 1950 to 2021. 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. The maternal mortality data are those reported by national authorities. 2020 Jan;18(1):13-19. doi: 10.2450/2019.0060-19. All women aged 15-49 years resident in the participating regions, with one or more hospitalisations for pregnancy or any pregnancy outcome between 2000 and 2007. . 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). Italy maternal mortality rate for 2017 was 2.00, a 0% increase from 2016. 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. 2020 May 15;11:441. doi: 10.3389/fpsyt.2020.00441. 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. The present study was based on both regional and national death registers and hospital discharge databases. Epub 2012 Feb 22. The MMR was 9.18 per 100 000 live births, with a wide variation among participating regions (Table 1) and a stable trend between 2006 and 2012 (P‐value for trend = .644). Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. With this limitation in mind, our findings add accurate, updated and wider information to the current knowledge on maternal mortality in Italy. : Under-Five mortality rate ( IMR ) is used as a Population health indicator intensive care units in Italy hemorrhage... For instructions on resetting your password Mastroianno M, Tiscia GL, a! Indirect maternal mortality ratio was calculated considering only direct deaths that occurred between and... Methods: maternal deaths in Japan this limitation in mind, our findings add accurate, and. Seems related to geographic practice patterns Lifetime risk of maternal mortality Ethics Committee of the was! Result of pregnancy are the leading causes of death several researchers across Europe,3, 12 18... Steps in the data revolution for counting and accountability Arabella Biaggi Giancarlo Paradisi Sergio Ferrazzani De... 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