Introduction: Maternal mortality is an important indicator for quality control in obstetrics. To improve clinical care, maternal mortality should be assessed periodically. In this study, we analysed maternal mortality cases between 2005 and 2014 in Switzerland and compared them with those in earlier periods.
Methods: The Federal Statistical Office (FSO) provided all death certificates between 2005 and 2014 with an ICD-10 code in the obstetric field (indicated with the letter O). Additionally, we included all death certificates that gave a positive answer about pregnancy or birth within the last 42 days. We also included cases where death occurred within 365 days after delivery. For an analysis of underreporting, cases from the Institute of Forensic Medicine (IRM), Zurich, were included. The cases were classified according to ICD-10 as “direct”, “indirect”, “non-pregnancy-related”, and “late” deaths. The direct maternal mortality rate (MMR), and indirect and combined MMRs were calculated.
Results: We received 117 cases from the FSO, and one additional case was found in the archives of the IRM. Ninety-six cases were eligible for detailed evaluation. As 787,025 live births were recorded between 2005 and 2014 in Switzerland, the direct MMR was 3.30/100,000 live births (26 cases). It has decreased by 20.5% compared with the MMR in 1995–2004 (4.15/100,000 live births, 32 cases; p = n.s.) and by 40.4% compared with the MMR in 1985–1994 (5.54/100,000 live births, 45 cases; odds ratio [OR] 0.6, p = 0.04, 95% confidence interval [CI] 0.37–0.97). The leading cause for direct maternal mortality in the current study period was haemorrhage (nine cases), followed by amniotic fluid embolisms and preeclampsia (five cases each). The indirect MMR was 3.68/100,000 live births. In this group, 13 women committed suicide and 8 women died of complications of pre-existing cardiac pathologies. Suicide was the leading cause of maternal deaths, had suicides been classified as direct obstetric cases. The combined MMR (direct and indirect) was 6.61/100,000 live births (52 cases) (OR 4.8–8.4). Of 41 non-pregnancy-related cases, almost half (20 cases) died of cancer within the first year after delivery. Lethality after caesarean section was 0.008‰ (2/231,385).
Conclusions: The trend of reducing direct maternal mortality as well as lethality after caesarean section continues. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. Indirect maternal mortality is increasing and specifically suicides need special attention. Precise documentation of all maternal deaths is essential to improve outcomes for future mothers.