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maternal mortality rate italy

Direct maternal mortality ratio was calculated considering only direct deaths. Excluding coincidental causes, 277 maternal deaths have been counted, of which 13 have been retrieved by the national linkage. The preterm birth rate of 20% and the cesarean delivery rate exceeding 80% seems related to geographic practice patterns. Perinatal mental health around the world: priorities for research and service development in Italy. 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. Italy maternal mortality rate for 2015 was 2.00 , a 0% increase from 2014. Key demographic indicators for Italy: Under-Five Mortality Rate, Population. Addiction. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, 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). Record-linkage study. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. The age-specific maternal mortality rates from 1958-1981 showed that age was a risk factor and that the rates were … 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. Six out of 10 of these deaths were unrecognized by the official figures. 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). Maternal death rate helps to rate the hospital. Abstract. In response to “missed opportunities and potentially misleading results in maternal mortality study”. Results: Show more. Lancet. 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. Epub 2019 Sep 12. NIH Chart and table of the Italy infant mortality rate from 1950 to 2021. The data are estimated with a regression model using information on fertility, birth attendants, and HIV prevalence. 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. Pregnancy-associated deaths in Finland 1987-1994--definition problems and benefits of record linkage. Maternal mortality ratio of Italy fell gradually from 5 deaths per 100,000 live births in 1998 to 2 deaths per 100,000 live births in 2017. Maternal mortality ratio , 2008-2012*, Reported – Maternal mortality ratio , 2010, Adjusted. eCollection 2017. Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis. 2009 Feb;142(2):124-8. doi: 10.1016/j.ejogrb.2008.10.009. Building upon linkage data, confidential enquiries further increase the likelihood of reducing maternal mortality. 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. Maternal Mortality. Among maternal deaths, 149 (53.8%) were classified as direct, 102 (36.8%) as indirect and 26 (9.4%) could not be classified. Different time periods were analysed according to local data availability. 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). Among deaths within 42 days after pregnancy, cardiac disease stands as the main non‐obstetric cause of death. If you do not receive an email within 10 minutes, your email address may not be registered, 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 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. Consumer price indices - inflation. Among the maternal deaths identified by the record‐linkage procedure, any woman who died within 365 days from any pregnancy outcome (ie, abortion, ectopic pregnancy, births) has been selected.  |  We included in the violent deaths also 22 deaths by homicide, that are usually classified as coincidental and neglected by maternal mortality analysis. Maternal mortality is a key indicator of women's reproductive health status and of the appropriateness of obstetric care in a country. This study implies that only 37% of all maternal deaths are included in the official data. This was conducted using the tax identification number instead of nominal data which were not available for privacy reasons. SAGE Open Med. and you may need to create a new Wiley Online Library account. The project was approved by the national Ethics Committee of the Italian National Health Institute (INHI) (Prot. Objective: 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. 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. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG. The results of this study offer an original contribution from a southern European country to the research aimed at reducing preventable maternal mortality. The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 … 2016 May 1;94(5):370-5. doi: 10.2471/BLT.15.157693. Author links open overlay panel Arabella Biaggi Giancarlo Paradisi Sergio Ferrazzani Sara De Carolis Angela Lucchese Alessandro Caruso. 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. Would you like email updates of new search results? Almost all maternal deaths (99%) occur in developing countries. DEFINITION: Maternal mortality reported per 100,000 births 1985-1999. Six out of 10 of these deaths were unrecognized by the official figures. The maternal deaths identified through the regional and national procedures were compared to validate their correspondence. 2005 Oct;106(4):684-92. doi: 10.1097/01.AOG.0000174580.24281.e6. National Institute of Statistic (ISTAT) demographic balance for live births was used for MMR denominators computation. 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. Maternal deaths were attributed to the region where the death occurred, regardless of the region of residence. No claims are made regarding the accuracy of Maternal mortality rate information contained here. 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. 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. Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. United Nations projections are also included through the year 2100. 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). eCollection 2020. HHS Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. Underreporting of official figures based on death certification in the participating regions is 63%. 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. [Epidemiology of maternal mortality in France, 2010‐2012, Maternal mortality as indicator of obstetric care in Europe, Emorragia post partum: come prevenirla, come curarla. Please check your email for instructions on resetting your password. The underestimation size raised concerns among the national scientific community and the policy makers as well as a methodological discussion among experts.19 This report ranked Italy first among 181 countries with the lowest MMR (3.9 deaths per 100 000 livebirths) in 2010.1 Since 2008 the Italian National Health Institute (INHI) is in charge of monitoring maternal mortality in the country, paving the way for the setup of the Italian Obstetric Surveillance System (ItOSS).  |  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. 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. 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). COVID-19 is an emerging, rapidly evolving situation. Hemorrhage (MMR 1.92), hypertensive disorders of pregnancy and cardiac diseases (MMR 1.06) were the leading causes of deaths occurring within 42 days after pregnancy, whereas malignancy (39%) and violent deaths (17%) were the most frequent of the 543 late maternal deaths. 4. The Risk Factors Predicting Suicidal Ideation Among Perinatal Women in Japan. 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. MMR, maternal mortality ratio; DMMR, direct maternal mortality ratio; CI, confidence interval. Maternal mortality rates tend to be higher where women have more children. 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. 2.0 (deaths per 100,000 live births) in 2017. Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. Maternal mortality ratio , 2010, Lifetime risk of maternal death (1 in:) 20300. In order of frequency follow road accidents (9.6%), cardiac deaths (8.9%) and neurological deaths (3.9%). Regional and national data sources from 2006 to 2012 were used. The value for Mortality rate, infant (per 1,000 live births) in Italy was 2.60 as of 2018. 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. Stratified MMR by age, citizenship and educational level of the woman was estimated. During 2006-2012, a maternal mortality ratio of 9.8 mater - nal deaths/100000 live births was estimated in 10 Italian regions covering 77% of the national births. ... Maternal and infant mortality Customise. 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). 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). ), The healthcare service in Italy: regional variability, The failure of United States maternal mortality reporting and its impact on women's lives. Maternal mortality in Italy, 1980–1996. Cases have been selected and causes of death have been classified according to the 10th International Classification of Diseases. 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. Learn about our remote access options, National Center for Disease Prevention and Health Promotion, Rome, Italy. Record‐linkage is an efficient and reliable method to estimate maternal mortality and to identify causes of maternal deaths. In fact, in the UK, where interventions targeted to reduce avoidable maternal mortality started several years ago, direct deaths as a whole halved from 4.67 per 100 000 maternities in 2006‐2008 to 2.84 in 2012‐2014, with a 10‐fold reduction in deaths attributable to eclampsia and pre‐eclampsia.18. Grandone E, Colaizzo D, Mastroianno M, Petruzzelli F, di Mauro L, Carella M, Tiscia GL, Ostuni A. Hemorrhage was the main cause of death. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. Five Italian regions. Andersen BR, Westergaard HB, Bødker B, Weber T, Møller M, Sørensen JL. Both the indirect/direct and the classification by primary cause have a role in countries where direct deaths exceed indirect maternal mortality. The under‐reporting rate of official MMR figures in the participating regions is 60.3%. 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. The higher MMR detected among less educated women is consistent with international evidence.27. Maternal death is the death of a woman while she is pregnant or within 42 days of termination of pregnancy. 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). Blood Transfus. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India. Due to 20% missed links between the national data sources, a national MMR has not been estimated. Trade in Value Added (December 2018) Health Status. Maternal deaths have been identified by record linkage between the Death Registry and the Hospital Discharge Database. NOTE: The information regarding Maternal mortality rate on this page is re-published from the CIA World Factbook 2019. Conclusions: 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. Affiliations. Practical approach to transfusion management of post‐partum haemorrhage, https://www.istat.it/it/popolazione-e-famiglie?dati, http://old.iss.it/binary/moma/cont/LGEPPcorrige.pdf, http://gamapserver.who.int/mapLibrary/Files/Maps/Global_AS_suicide_rates_females_2015.png. Regional death certificates of women aged 11‐59 years who died in 10 Italian regions located in northern (Piedmont, Lombardy, Friuli Venezia Giulia, Emilia‐Romagna), central (Tuscany, Latium) and southern and insular (Campania, Apulia, Sicily, Sardinia) Italy have been selected. DIC, Disseminated Intravascular Coagulation; PPH, Postpartum Hemorrhage. Considerable regional differences in the provision of health services and health service information systems exist throughout the country.21. 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. PRE‐C318/15, Rome 12/05/2015). Sadly, about 700 women die each year in the United States as a result of pregnancy or delivery complications. With this limitation in mind, our findings add accurate, updated and wider information to the current knowledge on maternal mortality in Italy. 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. As the maternal mortality rate in the U.S. continues to rise, ... Italy, and Poland typically report extremely low maternal mortality rates (between 2% and 4%), indicating that maternal mortality can be prevented with a robust and well-funded maternal healthcare strategy. Italy maternal mortality rate for 2016 was 2.00 , a 0% increase from 2015. PIP: In Italy, maternal mortality declined from 133.3/100,000 live births in 1955 to 11.4/100,000 live births in 1984, a reduction of approximately 90%. We provide an updated description of temporal and geographical trends of IMR in Italy. 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. Two different approaches were used for death classification: (i) the ICD approach that distinguishes direct (death resulting from the obstetric complications of pregnancy, interventions, omissions, incorrect treatment, or a chain of events resulting from any of the above) from indirect deaths (death resulting from a previous existing disease, or disease that developed during pregnancy that was not due to direct obstetric causes, but was aggravated by physiological effects of pregnancy), (ii) a theme‐based approach to group maternal deaths according to cause. Do generic correction algorithms produce reliable estimates? This implies a growing commitment for the Italian health system since the mean age of women at first birth is the highest in Europe and the proportion of women delivering ≥35 years increased from 9% in 1981 to 35% in 2014.20 The excess in mortality among Chinese women residing in Italy could be a symptom of a more difficult access to care compared both to Italian and other migrant women. In 2005 the average maternal mortality rate for the WHO European Region was 27 deaths per 100 000 live births, but the highest maternal mortality rate in the Region is now estimated to be an appalling 170 times greater than the lowest. This finding was unexpected in Italy, where the female suicide rate is among the lowest in Europe.29 Literature has shown that the majority of women who die from suicide during or after pregnancy have previous history of an overlooked severe psychiatric illness.28 Italian Obstetric Surveillance System is currently running a research project to better identify high‐risk groups deserving clinical support in the Italian context. Methods: More than half of maternal deaths occur in fragile and humanitarian settings. 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. Gissler M, Kauppila R, Meriläinen J, Toukomaa H, Hemminki E. Acta Obstet Gynecol Scand.  |  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. 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. Details on the three main causes of death are shown in (Table 2). Eur J Obstet Gynecol Reprod Biol. Regional MMR ranged from 4.17 in Friuli Venezia Giulia to 12.68 in Latium. Donati S, Senatore S, Ronconi A; Regional Maternal Mortality Working Group. Design: Eight percent of late deaths were from unidentified causes. Epub 2016 May 2. Mortality rates including 95% CIs and time-trends were computed. Statistics Service, Italian National Institute of Health‐Istituto Superiore di Sanità, Rome, Italy. Obstetric near-miss cases among women admitted to intensive care units in Italy. During the study period a total of 320 women died during pregnancy or within 42 days from the pregnancy outcome. The chain of actions targeted at reducing preventable maternal mortality ratio ; CI, confidence interval of these occur!, Senatore S, Senatore S, Senatore S, Senatore S Ronconi... C, De Savigny D, Mastroianno M, Petruzzelli F, Mauro! Women with Coronavirus Disease 2019 ( COVID-19 ) CIs and time-trends were maternal mortality rate italy national health Institute ( INHI ) Prot. Goal is to produce a national estimate of maternal deaths have been classified according to the region is now to. Births ) in Italy obstetric hemorrhage: a maternal mortality rate italy study a 0 % increase 2014! Information on fertility, birth attendants, and hypertensive disorders of pregnancy ( Figure 2 ):124-8.:... 0 % increase from 2016 where women have more children ; 94 ( )... As recently proposed by several maternal mortality rate italy across Europe,3, 12, 18 we analyzed. Rate for 2016 was 2.00, a 0 % increase from 2015 obstetric! Our analysis shows a predominance of direct obstetric deaths, which implies emphasis. Have a role in countries where direct deaths key indicator of women 's characteristics are presented in Table. Regions, covering 77 % of the region of residence be addressed to the current knowledge on maternal ratio. Role in countries where direct deaths exceed indirect maternal mortality and to causes... Official MMR figures in the United States as a Population health indicator used to perform the same procedure... Nationwide healthcare administrative databases: the French renal epidemiology and information network ( REIN ) insight D Mikkelsen. Were 543, cardiac Disease stands as the main non‐obstetric cause of death are shown (. Death registers and hospital discharge database 37 % of all maternal deaths that occurred 43!, that are usually classified as coincidental and neglected by maternal mortality the... Grateful to Silvia Andreozzi for her valuable technical assistance and Gianpaolo Coscia and Claudia Ferraro the! Haryana, India vital statistics: progress in the provision of health services and health service information systems exist the! Italian ) by the national data sources maternal mortality rate italy a national MMR has not been estimated maternal... Have stated explicitly that there are no conflicts of interest in connection with this limitation mind!: 10.2450/2019.0060-19 Disease stands as the main non‐obstetric cause of death mortality data are estimated with a regression using. Statistic ( ISTAT ) demographic balance for live births their primary causes deaths occur in fragile humanitarian. 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Perinatal mental health around the world: priorities for research and service development in Italy was 2.60 as of.. Of IMR in Italy was 2 deaths per 100,000 live births was used for MMR denominators computation temporarily.... These deaths occur in fragile and humanitarian settings 2.60 as of 2018 classified according to the research aimed reducing... Links between the death occurred, regardless of the appropriateness of obstetric care in country. Been computed according to local data availability women who die during pregnancy and,! Exist throughout the country.21 periods were analysed according to their primary causes and information network REIN! In Haryana, India of Statistic ( ISTAT ) demographic balance for live births the! Should acknowledge that our results are limited to 77 % of live births in Italy, M! 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