Maternal mortality in Italy: a record-linkage study.

OBJECTIVE 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. DESIGN Record-linkage study. SETTING Five Italian regions. POPULATION 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. METHODS Maternal deaths have been identified by record linkage between the Death Registry and the Hospital Discharge Database. Different time periods were analysed according to local data availability. Cases have been selected and causes of death have been classified according to the 10th International Classification of Diseases. MAIN OUTCOME MEASURE Maternal mortality ratio. RESULTS Underreporting of official figures based on death certification in the participating regions is 63%. 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. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. CONCLUSIONS This study implies that only 37% of all maternal deaths are included in the official data. Our analysis shows a predominance of direct obstetric deaths, which implies that emphasis is needed on improvements of obstetric care.