{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:04:37Z","timestamp":1790820277649,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T00:00:00Z","timestamp":1648598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>To calculate the maternal mortality ratio (MMR) for 2006\u20132018 in the Netherlands and compare this with 1993\u20132005, and to describe women\u2019s characteristics, causes of death and improvable factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>We performed a nationwide, cohort study of all maternal deaths between January 1, 2006 and December 31, 2018 reported to the Audit Committee Maternal Mortality and Morbidity. Main outcome measures were the national MMR and causes of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall MMR was 6.2 per 100 000\u00a0live births, a decrease from 12.1 in 1993\u20132005 (risk ratio [RR] 0.5). Women with a non\u2010western ethnic background had an increased MMR compared with Dutch women (MMR 6.5 vs. 5.0, RR 1.3). The MMR was increased among women with a background from Surinam\/Dutch Antilles (MMR 14.7, RR 2.9). Half of all women had an uncomplicated medical history (79\/161, 49.1%). Of 171 pregnancy\u2010related deaths within 1 year postpartum, 102 (60%) had a direct and 69 (40%) an indirect cause of death. Leading causes within 42\u00a0days postpartum were cardiac disease (<jats:italic>n<\/jats:italic>\u00a0=\u00a021, 14.9%), hypertensive disorders (<jats:italic>n<\/jats:italic>\u00a0=\u00a020, 14.2%) and thrombosis (<jats:italic>n<\/jats:italic>\u00a0=\u00a019, 13.5%). Up to 1 year postpartum, the most common cause of death was cardiac disease (<jats:italic>n<\/jats:italic>\u00a0=\u00a032, 18.7%). Improvable care factors were identified in 76 (47.5%) of all deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Maternal mortality halved in 2006\u20132018 compared with 1993\u20132005. Cardiac disease became the main cause. In almost half of all deaths, improvable factors were identified and women with a background from Surinam\/Dutch Antilles had a threefold increased risk of death compared with Dutch women without a background of migration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14312","type":"journal-article","created":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T11:56:12Z","timestamp":1648641372000},"page":"441-449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Confidential enquiry into maternal deaths in the Netherlands, 2006\u20132018"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6078-1185","authenticated-orcid":false,"given":"Athanasios F.","family":"Kallianidis","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joke M.","family":"Schutte","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Isala Hospital  Zwolle the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise E. M.","family":"Schuringa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid C. M.","family":"Beenakkers","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Wilhelmina Children\u2019s Hospital  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kitty W. M.","family":"Bloemenkamp","sequence":"additional","affiliation":[{"name":"Division Woman and Baby Department of Obstetrics Birth Center Wilhelmina\u2019s Children Hospital University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babette A. M.","family":"Braams\u2010Lisman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology  Tergooi Blaricum the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome","family":"Cornette","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Erasmus MC University Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone M.","family":"Kuppens","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Catharina Ziekenhuis  Eindhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna L.","family":"Rietveld","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam UMC Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timme","family":"Schaap","sequence":"additional","affiliation":[{"name":"Division Woman and Baby Department of Obstetrics Birth Center Wilhelmina\u2019s Children Hospital University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle","family":"Stekelenburg","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Global Health University Medical Center Groningen University of Groningen  Groningen the Netherlands"},{"name":"Department of Obstetrics and Gynecology Leeuwarden Medical Center  Leeuwarden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost J.","family":"Zwart","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Deventer Hospital  Deventer the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-9145","authenticated-orcid":false,"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center  Leiden the Netherlands"},{"name":"Athena Institute, VU  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,30]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"The WHO Application of ICD\u201010 to Deaths During Pregnancy, Childbirth and the Puerperium: ICD\u2010MM","author":"World Health Organization","year":"2012"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1258\/om.2008.080020"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2011.09.005"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002114"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02382.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(98)00053-0"},{"key":"e_1_2_11_9_1","unstructured":"World Health Organisation.Health in 2015: from MDGs to SDGs;2015."},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13493"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.01166.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60736-4"},{"key":"e_1_2_11_13_1","unstructured":"World Health Organisation.The WHO Application of ICD\u201010 to Deaths During Pregnancy Childbirth and the Puerperium: ICD\u2010MM;2012."},{"key":"e_1_2_11_14_1","unstructured":"Centers for Disease Control and Prevention.Maternal Mortality.2020. 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