Direct maternal deaths in Norway 1976-1995

Aims. To report direct maternal mortality ratio (MMR) in Norway between 1976 and 1995 including a description of the underlying complications in pregnancy, the causes of death and assessment of standard of care. Methods. The maternal deaths were identified through the Cause of Death Registry, Statistics Norway, and Medical Birth Registry of Norway. We requested copies of the hospital case records and the maternal death autopsies. The direct maternal deaths were classified on the basis underlying causes and assessed for substandard care according to the guidelines at the time of death and preventability provided optimal conditions and up to date guidelines. Results. In the period 1976-1995 we identified 61 direct maternal deaths in Norway. The direct MMR was 5.5/100,000 births. Sufficient information was available for analysis in 51 of these cases. Six deaths occurred in early pregnancy. Among the 45 women who gave birth, 32 had a cesarean section, and the death was judged to be related to a complication of the operation in more than half of these cases. The standard of care and the possibility of preventing death were evaluated in 49 cases. Substandard care was observed in 21 of them and 27 were considered avoidable or potentially avoidable. Conclusion. The direct MMR in Norway was 5.5/100,000 births. The main causes were complications of hypertensive disease of pregnancy and thromboembolism. The majority of maternal deaths were associated with cesarean delivery and considered potentially avoidable.