Abstract

Maternal mortality data and review are important indicators of the effectiveness of maternity healthcare systems and an impetus for action. Recently, a rising incidence of maternal mortality in high income countries has been reported. Various publications have raised concern about data collection methods at country level, as this usually relies mainly on national vital statistics. It is therefore essential that the collected data are complete and accurate and conform to international definitions and disease classification. Accurate data and review can only be truly available when an Enhanced Obstetric Surveillance System is in place. EBCOG calls for action by national societies to work closely with their respective ministries of health to ensure that high quality surveillance systems are in place.

Introduction

The death of a woman during pregnancy, childbirth or postpartum is a devastating outcome for any pregnancy and the maternal mortality rate serves as an important reflection of the maternity healthcare standards provided. In most high-income countries, the maternal mortality ratio (MMR) has become very low and appears to have remained stable for many years. The MMR in low-income regions has also gradually come down over the last two decades but remains persistently high [Fig. 1] [1]. On a global level, the highest burden of maternal mortality lies in lower and lower-middle income countries, where almost 95 % of all maternal deaths occur [2]. Even in some high-income countries, an apparent rise has become a matter of concern. In the United States, maternal mortality rates have been reported to have nearly doubled from 17.4 per 100,000 live births [LB] in 2018 to 32.9 in 2020 [3]. Europe has contrastingly seen a gradual fall in MMR from 26 per 100,000 LB in 2000 to 13 in 2020 [Fig. 1] [1]. Continuing MMR surveillance remains an valuable obstetric performance parameter. The importance of maternal healthcare and the efforts to reduce maternal mortality rates worldwide are reflected in the multiple statements and goals set by UN network agencies: “Millenium Development Goals”, “Sustainable Development Goals”, or the “Strategies toward ending preventable maternal mortality” [۴, ۵].

Conclusion

Enhanced obstetric surveillance systems are an indispensable component of quality assessment of maternal health care including in high income countries. High standards of case ascertainment and the reviewing and formulation of lessons learned lead to a better understanding of the events behind every maternal death and thus providing tools to improvements for future healthcare (Table 1). Involvement in the obstetric surveillance process should not only involve healthcare providers, but also the political/governmental authorities who should embrace and support the surveillance system by providing financial support and introducing legislation to protect anonymity and data. Systems must also be in place whereby fear of disciplinary or medico-legal procedures is reduced thus encouraging the healthcare providers to voluntarily come forward to report such cases. Only by ensuring that an effective Enhanced Obstetric Surveillance System is in place, can we ensure an improvement of maternal mortality death mortality numbers.