{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:54:50Z","timestamp":1789732490653,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,3,2]],"date-time":"2022-03-02T00:00:00Z","timestamp":1646179200000},"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":["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>Obstetric hemorrhage\u2010related deaths are rare in high income countries. Yet, with increasing incidences of obstetric hemorrhage in these countries, it is of utmost importance to learn lessons from each obstetric hemorrhage\u2010related death to improve maternity care. Our objective was to calculate the obstetric hemorrhage\u2010related maternal mortality ratio (MMR), assess causes of obstetric hemorrhage\u2010related deaths, and identify lessons learned.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Nationwide mixed\u2010methods prospective case\u2010series with confidential enquiries into maternal deaths due to obstetric hemorrhage in the Netherlands from January 1, 2006 to December 31, 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The obstetric hemorrhage\u2010related MMR in the Netherlands in 2006\u20132019 was 0.7 per 100\u2009000 livebirths and was not statistically significantly different compared with the previous MMR of 1.0 per 100\u2009000 livebirths in 1993\u20132005 (odds ratio 0.70, 95% confidence interval 0.38\u20131.30). Leading underlying cause of hemorrhage was retained placenta. Early recognition of persistent bleeding, prompt involvement of a senior clinician and timely management tailored to the cause of hemorrhage with attention to coagulopathy were prominent lessons learned. Also, timely recourse to surgical interventions, including hysterectomy, in case other management options fail to stop bleeding came up as an important lesson in several obstetric hemorrhage\u2010related deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The obstetric hemorrhage\u2010related MMR in the Netherlands in 2006\u20132019 has not substantially changed compared to the MMR of the previous enquiry in 1993\u20132005. Although obstetric hemorrhage is commonly encountered by maternity care professionals, it is important to remain vigilant for possible adverse maternal outcomes and act upon an ongoing bleeding following birth in a more timely and adequate manner. Our confidential enquiries still led to important lessons learned with clinical advice to professionals as how to improve maternity care and avoid maternal deaths. Drawing lessons from maternal deaths should remain a qualitative and moral imperative.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14321","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T06:34:53Z","timestamp":1646289293000},"page":"450-460","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Nationwide confidential enquiries into maternal deaths because of obstetric hemorrhage in the Netherlands between 2006 and 2019"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9753-3983","authenticated-orcid":false,"given":"Paul I.","family":"Ramler","sequence":"first","affiliation":[{"name":"Center for Clinical Transfusion Research Sanquin Research  Leiden the Netherlands"},{"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 University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1377-4625","authenticated-orcid":false,"given":"Kitty W. M.","family":"Bloemenkamp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Birth Center, Wilhelmina Children\u2019s Hospital Division Woman and Baby University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-2475","authenticated-orcid":false,"given":"Johanna G.","family":"Van der Bom","sequence":"additional","affiliation":[{"name":"Center for Clinical Transfusion Research Sanquin Research  Leiden the Netherlands"},{"name":"Department of Clinical Epidemiology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babette A. M.","family":"Braams\u2010Lisman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Tergooi Hospital  Blaricum the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8482-5138","authenticated-orcid":false,"given":"J\u00e9r\u00f4me M. J.","family":"Cornette","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Erasmus University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6078-1185","authenticated-orcid":false,"given":"Athanasios F.","family":"Kallianidis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1922-9975","authenticated-orcid":false,"given":"Simone M. I.","family":"Kuppens","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Catharina Hospital  Eindhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6446-159X","authenticated-orcid":false,"given":"Anna L.","family":"Rietveld","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam VU University Medical Center  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9772-3592","authenticated-orcid":false,"given":"Timme P.","family":"Schaap","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Birth Center, Wilhelmina Children\u2019s Hospital Division Woman and Baby University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2362-8602","authenticated-orcid":false,"given":"Joke M.","family":"Schutte","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Isala Hospital  Zwolle the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-6620","authenticated-orcid":false,"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, Faculty of Science VU University  Amsterdam the Netherlands"},{"name":"National Perinatal Epidemiology Unit University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/72.1.241S"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000187894.71913.e8"},{"key":"e_1_2_10_6_1","unstructured":"Centers for Disease Control and Prevention Reproductive Health. 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