Halving maternal mortality in the Netherlands

Halving maternal mortality in the Netherlands

The risk of death is higher with a caesarean section than with a vaginal birth

The number of women who die before, during or after giving birth in the Netherlands has halved in recent years. Athanasios Kallianidis, a gynecologist in training, discovered this during his PhD research at the Leiden University Medical Center (LUMC). He also saw that the risk of death is higher with a caesarean section than with a vaginal delivery.

Between 2006 and 2018, 171 women died in the Netherlands during pregnancy, childbirth and up to and including 1 year after childbirth. Compared to the 13 years before, this is a halving of the mortality risk. The most notable difference is that the main cause is cardiovascular disease (19%), while preeclampsia used to be the most common cause of death. The number of deaths due to preeclampsia has fallen from 30% to 12%.

Risk is still very low
Another important finding is that the way of giving birth also influences the risk of mortality. Women who had a caesarean section were three times more likely to die than women who gave birth vaginally. And 1 in 10 deaths after a cesarean section were a direct result of the operation. But there is also good news. The absolute risk of dying after caesarean section is still very low, at 13 women per 100,000 caesarean sections, and has fallen sharply since the 1990s.

Several risk factors play a role
High-risk groups of maternal mortality are teenagers, older women and women of Surinamese or Antillean descent. Probably intersectionality. This means that several risk factors are present at the same time, such as: poverty, a language barrier, health problems and/or an unplanned pregnancy. “In the future, we hope to find out how it is possible that these women, despite the fact that we have known for some time that they are more at risk, still lose out,” says Kallianidis.

Kallianidis used data collected by the Maternal Mortality and Morbidity Audit Committee for this study. This registers every death of a woman during pregnancy and up to and including 1 year after giving birth.

Uterine removal after cesarean section
In addition to insight into the frequency of maternal deaths, Kalliandis’ goal was to improve the care provided. “We looked specifically at hysterectomy. This is a last resort in case of very serious blood loss or serious infections during childbirth,” says the LUMC researcher. He compared the results from the Netherlands with those from 9 other European countries. “We saw that hysterectomy was more common in countries with a higher caesarean section rate. The results of this study emphasize that the short-term risks and complications of caesarean section should not be underestimated, especially with the knowledge that the number of caesarean sections worldwide has been rising rapidly for years,” says Kallianidis.

Improving care
The PhD student also saw that women are increasingly dying from non-pregnancy-related conditions, such as cardiovascular disease. These conditions develop or worsen during pregnancy. “It is therefore extremely important that all healthcare providers recognize this in time and treat it by working well together. The general practitioner, the obstetrician and the specialists in the hospital all have their own role in this, but together they form a team.”

Kallianidis hopes that his results will contribute to further reducing maternal mortality in the future. “More knowledge about the causes of maternal mortality is crucial to improve care for pregnant women.”

Source: LUMC

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