• N Schuitemaker, J van Roosmalen, G Dekker, P van Dongen, H van Geijn, and J Bennebroek Gravenhorst.
• Department of Obstetrics and Gynaecology, Diakonessenhuis Utrecht, The Netherlands.
• Eur. J. Obstet. Gynecol. Reprod. Biol. 1998 Jul 1; 79 (1): 57-62.

ObjectiveTo determine the causes of maternal death in The Netherlands.Study DesignNationwide Confidential Enquiry into the Causes of Maternal Deaths during the period 1983-1992.ResultsOf 192 direct and indirect maternal deaths, 154 (80%) were available for the Enquiry. The most frequent direct causes were (pre-)eclampsia, thrombo-embolism, obstetrical haemorrhage and sepsis. Cerebro- and cardiovascular disorders were the most frequent indirect causes of death. Age above 35 years and parity 3 or more are related to higher maternal mortality. Women from non-caucasian origin are more prone to death in comparison to caucasian women. Autopsy was performed in 88 cases (57%). Of the 24 women where labour started at home, the place of birth played a significant role in delay in four.ConclusionsMore efforts should be made to have a higher percentage than 80% available for the Confidential Enquiry as in the UK where only 1-4% of deaths are not available for similar purposes. Also, the autopsy rate of 57% is much lower than in the UK (82%). Special strategies should be developed to improve maternal health of populations at higher risk such as women of high age and parity and immigrant populations.

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