Maternal mortality in developed countries: Not just a concern of the past

OBJECTIVE: To review the activities in selected developed countries for strategies to identify maternal deaths, the impact of these strategies on underreporting, and the information needed to understand the events leading to death. DATA SOURCES: We reviewed the literature from the United States, Europe, and Australia for publications dealing with maternal death identification and investigation from 1980 to April 1995. We also obtained information directly from researchers involved in major maternal mortality studies. METHODS OF STUDY SELECTION: We included all 31 reports (from 14 countries) that discussed methods to improve the ascertainment of maternal deaths beyond the routine use of vital registration. Because of the nature of the subject matter, almost all reports relied on descriptive epidemiology. DATA EXTRACTION AND SYNTHESIS: We found that a variety of methods can be used to improve the ascertainment of maternal deaths, including linkage of birth and fetal death certificates, check-boxes on death certificates, periodic review of deaths of reproductive-age women, and ongoing birth registries and medical audits. Information from a variety of sources is also needed to understand the events leading to death. CONCLUSION: The numbers of deaths due to pregnancy and its complications are underestimated in most developed countries. Improved ascertainment of maternal death is needed to determine the magnitude of the problem and to assess trends and identify risk groups, allowing development of appropriate and effective strategies to prevent the morbidity and mortality associated with pregnancy.