Analysis of maternal mortality in Berlin, Germany – discrepancy between reported maternal mortality and comprehensive death certificate exploration
-
Julia Callaghan
Abstract
Objectives
The Organisation for Economic Cooperation and Development (OECD) estimates an average maternal mortality rate (MMR) of around 3.4 maternal deaths per 100,000 live births for 2019–2021, based on relevant diagnoses on death certificates. However, Germany does not currently have a registry for recording the number of maternal deaths. The aim of this study is to identify the actual number of maternal deaths in Berlin between 2019 and 2022, as well as sources of underreporting and causes of death.
Methods
Potential maternal mortality cases were identified through a search at the Berlin Central Archive for Death Certificates, inquiring women aged 15–50 years with indications of present or recent pregnancy on the death certificate. To cross match the database, an additional search at the Charité University Hospital Berlin was carried out, checking each individual file for pregnancy-association.
Results
The data search resulted in 2,316 women, 18 of which presented an association to pregnancy. Of these, 12 could be classified as maternal mortality cases (MMR 7.8/100,000). The additional search in a university setting revealed two further maternal mortality cases without prior indication of pregnancy on the death certificate. This results in a total MMR of 9.1/100,000 live births, which is over double the official estimate by the OECD.
Conclusions
Based on our findings in Berlin, it can be estimated that there is significant underreporting regarding maternal death cases in Germany. A more comprehensive recording system is needed to more accurately portray maternal mortality.
-
Research ethics: Ethical approval was received from the Ethics Committee of Charité university hospital (EA1/156/23).
-
Informed consent: Not applicable.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Research funding: None declared.
-
Data availability: The raw data can be obtained on request from the corresponding author.
References
1. WHO. Maternal deaths: World Health Organization [Online]. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4622 [Accessed 19 Sep 2023].Search in Google Scholar
2. CDC. Pregnancy mortality surveillance system [Online]. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm [Accessed 19 Sep 2023].Search in Google Scholar
3. Bailey, E. More action needed to reduce global maternal mortality [Online]. https://blogs.bmj.com/ebn/2023/04/09/more-action-needed-to-reduce-global-maternal-mortality/ [Accessed 19 Sep 2023].Search in Google Scholar
4. WHO. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2023. Report No. 978 92 4 006875 9.Search in Google Scholar
5. UN. Millennium Summit, 6-8 September 2000, New York [Online]. https://www.un.org/en/conferences/environment/newyork2000 [Accessed 19 Sep 2023].Search in Google Scholar
6. UN. SDG indicators: regional groupings used in report and statistical annex [Online]. https://unstats.un.org/sdgs/indicators/regional-groups/ [Accessed 19 Sep 2023].Search in Google Scholar
7. WHO. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer [Online]. https://iris.who.int/handle/10665/42984 [Accessed 19 Sep 2023].Search in Google Scholar
8. Bamber, JH, Kinsella, SM. MBRRACE-UK – the new home for the confidential enquiries into maternal deaths – reports for the first time. Anaesthesia 2015;70:5–9, https://doi.org/10.1111/anae.12938.Search in Google Scholar PubMed
9. OECD. OECD health statistics 2023 [Online]. https://www.oecd.org/health/health-data.htm [Accessed 19 Sep 2023].Search in Google Scholar
10. Senatsverwaltung für Justiz- und Verbraucherschutz: Gesetz- und Verordnungsblatt, Art.-Nr. 76491420, 70. Jahrgang Nr. 20, 13 Aug 2014.Search in Google Scholar
11. Lin, CY, Tsai, PY, Wang, LY, Chen, G, Kuo, PL, Lee, MC, et al.. Changes in the number and causes of maternal deaths after the introduction of pregnancy checkbox on the death certificate in Taiwan. Taiwan J Obstet Gynecol 2019;58:680–3, https://doi.org/10.1016/j.tjog.2019.07.017.Search in Google Scholar PubMed
12. Davis, NL, Hoyert, DL, Goodman, DA, Hirai, AH, Callaghan, WM. Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978-2012. Am J Obstet Gynecol 2017;217:352.e1–7, https://doi.org/10.1016/j.ajog.2017.04.042.Search in Google Scholar PubMed PubMed Central
13. Diguisto, C, Saucedo, M, Kallianidis, A, Bloemenkamp, K, Bødker, B, Buoncristiano, M, et al.. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study. BMJ 2022;379:e070621, https://doi.org/10.1136/bmj-2022-070621.Search in Google Scholar PubMed PubMed Central
14. Hellmeyer, L, Zinn-Kirchner, Z, Königbauer, JT. Maternal mortality in the city of Berlin: consequences for perinatal healthcare. J Perinat Med 2023;51:182–7, https://doi.org/10.1515/jpm-2021-0604.Search in Google Scholar PubMed
15. WHO. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. Geneva: World Health Organization; 2012.Search in Google Scholar
16. Amt für Statistik Berlin-Brandenburg. Statistischer Bericht A II 1 – j/ 22 Eheschließungen, Geborene und Gestorbene in Berlin 2022. Potsdam: Amt für Statistik Berlin-Brandenburg; 2023.Search in Google Scholar
17. IQTIG. Qualitätsreport 2020. Berlin: IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; 2020.Search in Google Scholar
18. IQTIG. Rückmeldebericht für den Leistungserbringer Perinatalmedizin: Geburtshilfe Erfassungsjahr 2022 Standort: be+lkg#gem15mh6prau. Berlin: IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; 2023.Search in Google Scholar
19. Charité. Jahresbericht 2019 [Online]. https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2019.pdf [Accessed 23 Sep 2023].Search in Google Scholar
20. Charité. Jahresbericht 2020 [Online]. https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2020.pdf [Accessed 23 Sep 2023].Search in Google Scholar
21. Charité. Jahresbericht 2021 [Online]. https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2021.pdf [Accessed 23 Sep 2023].Search in Google Scholar
22. Charité. Jahresbericht 2022 [Online]. https://www.charite.de/fileadmin/user_upload/portal_relaunch/Mediathek/publikationen/jahresberichte/Charite-Jahresbericht_2022_DE.pdf [Accessed 23 Sep 2023].Search in Google Scholar
23. IQTIG. Jahresauswertung 2019 Geburtshilfe 16/1 Charité – Universitätsmedizin Berlin Klinik für Geburtsmedizin und Berlin Gesamt. Berlin: IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen; 2020.Search in Google Scholar
24. Knight, M, Bunch, K, Patel, R, Shakespeare, J, Kotnis, R, Kenyon, S, et al.. Saving lives, improving mothers’ care core report – lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018-20. Oxford: University of Oxford, National Perinatal Epidemiology Unit; 2022.Search in Google Scholar
25. Chmielewska, B, Barratt, I, Townsend, R, Kalafat, E, van der Meulen, J, Gurol-Urganci, I, et al.. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021;9:e759–2, https://doi.org/10.1016/s2214-109x(21)00079-6.Search in Google Scholar PubMed PubMed Central
26. Villar, J, Ariff, S, Gunier, RB, Thiruvengadam, R, Rauch, S, Kholin, A, et al.. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr 2021;175:817–26, https://doi.org/10.1001/jamapediatrics.2021.1050.Search in Google Scholar PubMed PubMed Central
27. Calvert, C, John, J, Nzvere, FP, Cresswell, JA, Fawcus, S, Fottrell, E, et al.. Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review. Glob Health Action 2021;14:1974677, https://doi.org/10.1080/16549716.2021.1974677.Search in Google Scholar PubMed PubMed Central
28. Robert-Koch-Institut. 7-Tage-Inzidenz der COVID-19-Fälle in Deutschland Berlin [Online]. https://zenodo.org/record/8336801 [Accessed 19 Sep 2023].Search in Google Scholar
29. MacDorman, MF, Declercq, E. The failure of United States maternal mortality reporting and its impact on women’s lives. Birth 2018;45:105–8, https://doi.org/10.1111/birt.12333.Search in Google Scholar PubMed PubMed Central
© 2023 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Corner of Academy
- The outcome of reduced and non-reduced triplet pregnancies managed in a tertiary hospital during a 15-year-period – a retrospective cohort study
- Original Articles – Obstetrics
- Parental refusal of prenatal screening for aneuploidies
- Analysis of maternal mortality in Berlin, Germany – discrepancy between reported maternal mortality and comprehensive death certificate exploration
- Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia
- Incidence and first trimester risk factors of stillbirth in Indonesia
- Correlation of fetal heart rate dynamics to inflammatory markers and brain-derived neurotrophic factor during pregnancy
- Preliminary assessment of the Healthy Early Life Moments (HELMS) webinars in empowering Developmental Origins of Health and Disease (DOHaD) concept among healthcare professionals – a pragmatic serial cross-sectional study
- Original Articles – Fetus
- The changing Doppler patterns and perinatal outcomes of monochorionic diamniotic twins with selective fetal growth restriction
- Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study
- Original Articles – Neonates
- Prediction of bronchopulmonary dysplasia by the chest radiographic thoracic area on day one in infants with exomphalos
- Impact of birth weight to placental weight ratio and other perinatal risk factors on left ventricular dimensions in newborns: a prospective cohort analysis
- Changes in regional tissue oxygen saturation values during the first week of life in stable preterm infants
- Letters to the Editor
- Optimal closure of the uterus during cesarean section: beyond the two layers
- Reply to: “Optimal closure of the uterus during cesarean section: beyond the two layers” commenting on “The effect of uterine closure technique on cesarean scar niche development after multiple cesarean deliveries”
Articles in the same Issue
- Frontmatter
- Corner of Academy
- The outcome of reduced and non-reduced triplet pregnancies managed in a tertiary hospital during a 15-year-period – a retrospective cohort study
- Original Articles – Obstetrics
- Parental refusal of prenatal screening for aneuploidies
- Analysis of maternal mortality in Berlin, Germany – discrepancy between reported maternal mortality and comprehensive death certificate exploration
- Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia
- Incidence and first trimester risk factors of stillbirth in Indonesia
- Correlation of fetal heart rate dynamics to inflammatory markers and brain-derived neurotrophic factor during pregnancy
- Preliminary assessment of the Healthy Early Life Moments (HELMS) webinars in empowering Developmental Origins of Health and Disease (DOHaD) concept among healthcare professionals – a pragmatic serial cross-sectional study
- Original Articles – Fetus
- The changing Doppler patterns and perinatal outcomes of monochorionic diamniotic twins with selective fetal growth restriction
- Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study
- Original Articles – Neonates
- Prediction of bronchopulmonary dysplasia by the chest radiographic thoracic area on day one in infants with exomphalos
- Impact of birth weight to placental weight ratio and other perinatal risk factors on left ventricular dimensions in newborns: a prospective cohort analysis
- Changes in regional tissue oxygen saturation values during the first week of life in stable preterm infants
- Letters to the Editor
- Optimal closure of the uterus during cesarean section: beyond the two layers
- Reply to: “Optimal closure of the uterus during cesarean section: beyond the two layers” commenting on “The effect of uterine closure technique on cesarean scar niche development after multiple cesarean deliveries”
