{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:46:38Z","timestamp":1792244798571,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T00:00:00Z","timestamp":1613865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006095","name":"Helse S\u00f8r-\u00d8st RHF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006095","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cardiovascular diseases have become increasingly important as a cause of maternal death in the Nordic countries. This is likely to be associated with a rising incidence of pregnant women with congenital and acquired cardiac diseases. Through audits, we aim to prevent future maternal deaths by identifying causes of death and suboptimal factors in the clinical management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Maternal deaths in the Nordic countries from 2005 to 2017 were identified through linked registers. The national audit groups performed case assessments based on hospital records, classified the cause of death, and evaluated the standards of clinical care provided. Key messages were prepared to improve treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 227 maternal deaths, giving a maternal mortality rate of 5.98 deaths per 100\u00a0000 live births. The most common cause of death was cardiovascular disease (n\u00a0=\u00a036 deaths). Aortic dissection\/rupture, myocardial disease, and ischemic heart disease were the most common diagnoses. In nearly 60% of the cases, the disease was not recognized before death. In more than half of the deaths, substandard care was identified (59%). In 11 deaths (31%), improvements to care that may have made a difference to the outcome were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Between 2005 and 2017, cardiovascular diseases were the most common causes of maternal deaths in the Nordic countries. There appears to be a clear potential for a further reduction in these maternal deaths. Increased awareness of cardiac symptoms in pregnant women seems warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14104","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T05:07:08Z","timestamp":1612328828000},"page":"1273-1279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["The impact of cardiovascular diseases on maternal deaths in the Nordic countries"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8979-1563","authenticated-orcid":false,"given":"Lill T.","family":"Nyfl\u00f8t","sequence":"first","affiliation":[{"name":"Norwegian Research center for Women's Health Oslo University Hospital Oslo Norway"},{"name":"Department of Obstetrics Drammen Hospital Drammen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Rigshospitalet University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajlana","family":"Mulic\u2010Lutvica","sequence":"additional","affiliation":[{"name":"Institution for Women's and Children's Health Department for Obstetrics and Gynecology Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Information Services Department THL Finnish Institute for Health and Welfare Helsinki Finland"},{"name":"Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"B\u00f8dker","sequence":"additional","affiliation":[{"name":"Nordsj\u00e6llands Hospital Hiller\u00f8d Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Bremme","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institute Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liv","family":"Ellingsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Oslo University Hospital Rikshospitalet Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4681-4774","authenticated-orcid":false,"given":"Siri","family":"Vangen","sequence":"additional","affiliation":[{"name":"Norwegian Research center for Women's Health Oslo University Hospital Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,21]]},"reference":[{"key":"e_1_2_10_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: Executive Summary","year":"2019"},{"key":"e_1_2_10_3_1","unstructured":"OECD Health Data 2020.https:\/\/stats.oecd.org\/. Accessed August 10 2020."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13172"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003497"},{"key":"e_1_2_10_6_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 2015\u201017","author":"Knight M","year":"2019"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-019-01340-w"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz136"},{"key":"e_1_2_10_9_1","volume-title":"Mother and Babies: Saving Lives, Improving Mother's Care \u2013 Surveillance of Maternal Deaths in the UK 2012\u201014 and Lessons Learned to Inform Maternity Care form the UK and Ireland Confidential Enquires into Maternal Deaths and Morbidity 2009\u201014","author":"Knight M","year":"2015"},{"key":"e_1_2_10_10_1","volume-title":"Time to Respond: A Report on the Global Implementation of Maternal Death Surveillance and Response","year":"2016"},{"key":"e_1_2_10_11_1","unstructured":"Norwegian Institute of Public Health.The Medical Birth Register of Norway.www.fhi.no. Accessed August 10 2020."},{"key":"e_1_2_10_12_1","unstructured":"Finnish Institute of Health and Welfare (THL).Perinatal statistics in the Nordic countries. Statistical Report 13\/2020.https:\/\/thl.fi\/en\/web\/thlfi\u2010en\/statistics\/statistics\u2010by\u2010topic\/sexual\u2010and\u2010reproductive\u2010health\/parturients\u2010deliveries\u2010and\u2010births\/nordic\u2010perinatal\u2010statistics. Accessed September 15 2020."},{"key":"e_1_2_10_13_1","unstructured":"Danish Health Data Authority.The Medical Birth Register of Denmark.https:\/\/www.esundhed.dk\/Registre\/Det\u2010medicinske\u2010foedselsregister. Accessed October 20 2020."},{"key":"e_1_2_10_14_1","unstructured":"Danish Endocrinological Society.https:\/\/endocrinology.dk\/nbv\/diabetes\u2010melitus\/diabetes\u2010og\u2010graviditet\/. 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