Objective To compare maternal mortality in eight countries with enhanced surveillance systems. Design Descriptive multicountry population based study. Setting Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia. Population 297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18). Outcome measures Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country’s office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women’s origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated. Results Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy. Conclusions Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries. No additional data available.

中文翻译：

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加强监测系统的八个欧洲国家的孕产妇死亡率：基于人群的描述性研究

目的 比较八个监测系统得到加强的国家的孕产妇死亡率。设计基于多国人口的描述性研究。设置 八个国家拥有永久监测系统，使用改进的方法来识别、记录和审查孕产妇死亡。最新的汇总孕产妇死亡率数据收集了法国、意大利和英国的三年期数据以及丹麦、芬兰、荷兰、挪威和斯洛伐克的五年期数据。人口 丹麦（2013-17 年）活产 297,835 人，芬兰（2008-12 年）301,169 人，法国（2013-15 年）2,435,583 人，意大利（2013-15 年）1,281,986 人，荷兰 856,572 人（2014-18 年）、挪威 292 315 人（2014-18 年）、斯洛伐克 283 930 人（2014-18 年）和英国 2 261 090 人（2016-18 年）。结果测量 计算增强系统的孕产妇死亡率，并将其与从每个国家的生命统计办公室获得的数据进行比较。特定年龄的孕产妇死亡率；按妇女出身、公民身份或种族划分的孕产妇死亡率；还计算了特定原因的孕产妇死亡率。结果 各国（荷兰除外）识别和分类 42 天以内孕产妇死亡的方法非常相似。妊娠结束后 42 天以内的孕产妇死亡率乘以四倍，从挪威和丹麦的每 10 万活产 2.7 和 3.4 到英国的 9.6 和斯洛伐克的 10.9。除丹麦外，生命统计办公室将孕产妇死亡率低估了 36% 或更多。最年轻和最年长母亲的特定年龄孕产妇死亡率更高（20 岁以下女性的合并相对风险为 2.17（95% 置信区间 1.38 至 3.34），35-39 岁女性为 2.10（1.54 至 2.86），3.95（ 3.01 至 5.19）对于年龄≥40 岁的人，与 20-29 岁的女性相比）。除挪威外，出生在国外或少数民族的妇女的孕产妇死亡率高出 ≥ 50%，不同国家的定义各不相同。心血管疾病和自杀是每个国家孕产妇死亡的主要原因。其他一些病症也只是一两个国家孕产妇死亡率的主要原因：英国和荷兰的静脉血栓栓塞症、荷兰的高血压疾病、法国的羊水栓塞、意大利的出血和斯洛伐克的中风。只有两个国家，法国和英国改进了研究晚期孕产妇死亡的方法，这些孕产妇死亡发生在妊娠结束后 43 至 365 天之间。结论 监测系统得到加强的高收入欧洲国家之间孕产妇死亡率存在差异。需要深入分析国家层面的护理质量和卫生系统绩效差异，以通过学习最佳实践和相互学习进一步降低孕产妇死亡率。所有国家都必须优先考虑妇女怀孕期间和怀孕后的心血管疾病和心理健康问题。没有可用的额外数据。结论 监测系统得到加强的高收入欧洲国家之间孕产妇死亡率存在差异。需要深入分析国家层面的护理质量和卫生系统绩效差异，以通过学习最佳实践和相互学习进一步降低孕产妇死亡率。所有国家都必须优先考虑妇女怀孕期间和怀孕后的心血管疾病和心理健康问题。没有可用的额外数据。结论 监测系统得到加强的高收入欧洲国家之间孕产妇死亡率存在差异。需要深入分析国家层面的护理质量和卫生系统绩效差异，以通过学习最佳实践和相互学习进一步降低孕产妇死亡率。所有国家都必须优先考虑妇女怀孕期间和怀孕后的心血管疾病和心理健康问题。没有可用的额外数据。