{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:21:52Z","timestamp":1790360512244,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To apply the iceberg model, quantifying absolute and relative incidence, to the four main causes of maternal morbidity and mortality in Ireland: haemorrhage, hypertension, sepsis and thrombosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Secondary analysis of national data on maternal morbidity and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Republic of Ireland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or sample<\/jats:title><jats:p>Approximately 715\u2009000 maternities, 1\u2009200\u2009000 maternal hospitalisations, 2138 cases of severe maternal morbidity (SMM) and 54 maternal deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Incidence rates and case\u2010fatality ratios were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Maternal death, SMM and hospitalisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At the \u2018tip of the iceberg\u2019, the incidence of maternal death per 10\u2009000 maternities was 0.09 (95% CI 0.03\u20130.20) due to thrombosis and 0.03 (95% CI 0\u20130.11) due to haemorrhage, hypertension disorders or sepsis. For one death due to thrombosis there were 35 cases of pulmonary embolism and 257 thrombosis hospitalisations. For one death due to eclampsia, there were 58 eclampsia cases, 13\u2009040 hospitalisations with pre\u2010existing hypertension and 40\u2009781 hospitalisations with gestational hypertension. For one death due to pregnancy\u2010related sepsis, there were 92 cases of septicaemic shock and 9005 hospitalisations with obstetric sepsis. For one maternal death due to haemorrhage, there were 1029 cases of major obstetric haemorrhage and 53\u2009715 maternal hospitalisations with haemorrhage. For every 100 maternities, there were approximately 16 hospitalisations associated with haemorrhage, 12 associated with hypertension disorders, three with sepsis and 0.2 with thrombosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Haemorrhage and hypertension disorders are leading causes of maternal morbidity in Ireland but they have very low case fatality. This indicates that these morbidities are managed effectively but their prevention requires more focus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Study shows that haemorrhage and hypertension are main causes of #maternalmorbidity in Ireland. Timely interventions for #maternalhealth and focus on prevention of severe and non\u2010severe morbidities are needed.<\/jats:p><jats:p>@NPEC #maternityservices #clinicalaudit #qualityimprovement.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16880","type":"journal-article","created":{"date-parts":[[2021,8,29]],"date-time":"2021-08-29T02:06:56Z","timestamp":1630202816000},"page":"402-411","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Maternal morbidity and mortality: an iceberg phenomenon"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1052-4695","authenticated-orcid":false,"given":"S","family":"Leitao","sequence":"first","affiliation":[{"name":"National Perinatal Epidemiology Centre University College Cork Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Manning","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Centre University College Cork Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RA","family":"Greene","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Centre University College Cork Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1201-7136","authenticated-orcid":false,"given":"P","family":"Corcoran","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Centre University College Cork Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Maternal Morbidity Advisory Group*","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Trends in Maternal Mortality: 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division","author":"World Health Organization","year":"2019"},{"key":"e_1_2_7_3_1","unstructured":"ButlerJ ErkenA HurskinI PassanisiD SaidR SmithP editors.Accelerating the promise \u2013 the report on the Nairobi Summit on ICPD25.New York NY:United Nations Population Fund;2020."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10262.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2006.06.003"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.117564"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-0218.137145"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0789-4"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-5-6"},{"key":"e_1_2_7_10_1","volume-title":"Saving Lives, Improving Mothers' Care \u2013 Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014\u201016","author":"Knight MBK","year":"2018"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0527-2"},{"key":"e_1_2_7_12_1","unstructured":"Oxford Reference iceberg phenomenon.2021[www.oxfordreference.com\/view\/10.1093\/oi\/authority.20110803095955847]. 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