OBSTETRICS| Volume 32, ISSUE 12, P1140-1146, December 2010

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Maternal Mortality and Severe Maternal Morbidity Surveillance in Canada

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      The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada.


      Le Système canadien de surveillance périnatale a fourni une analyse exhaustive de la mortalité maternelle et de la morbidité maternelle grave au Canada, et a identifié plusieurs limites importantes en ce qui concerne les systèmes nationaux existants de collecte de données maternelles, y compris la variabilité pour ce qui est du détail et de la qualité des données sur la mortalité. Le rapport du Système canadien de surveillance périnatale a recommandé la mise sur pied d’un système national continu d’analyse et de signalement, ainsi que le maintien d’une uniformité dans les définitions et les classifications de la mortalité maternelle et de la morbidité maternelle grave, et ce, afin d’améliorer la surveillance de la mortalité maternelle et de la morbidité maternelle grave. En utilisant des articles et des études d’analyse ayant examiné la mortalité maternelle en général (par opposition avec la mortalité maternelle associée à des stratégies de prise en charge ou à des pathologies particulières), les classifications, la terminologie et les statistiques comparatives portant sur la morbidité grave et la mortalité maternelles ont été analysées et utilisées pour évaluer les lacunes des méthodes passées et actuelles de collecte de données et pour chercher des solutions visant à répondre au besoin d’établir un système national amélioré et uniforme de surveillance de la mortalité maternelle et de la morbidité maternelle grave au Canada.

      Key Words


        • Maternal Health Study Group of the Canadian Perinatal Surveillance System
        Special report on maternal mortality and severe morbidity in Canada. Enhanced surveillance: the path to prevention. Health Canada, Ottawa2004 (Available at, Accessed April 9, 2010)
        • Say L.
        • Pattison R.C.
        • Gülmezoglu A.M.
        WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss).
        Reprod Health. 2004; 1: 3–4755–1-3
        • Say L.
        • Souza J.P.
        • Pattison R.C.
        WHO working group on maternal mortality and morbidity classifications, Maternal near miss—towards a standard tool for monitoring quality of maternal health care.
        Best Pract Res Clin Obstet Gynaecol. 2009; 23: 287-296
        • Pattinson R.
        • Say L.
        • Souza J.P.
        • van den Broek N.
        • Rooney C.
        WHO maternal death and near-miss classifications.
        Bull World Health Organ. 2009; 87 (Available at, Accessed April 9, 2010): 733-804
        • Hoyert D.L.
        • Danel I.
        • Tully P.
        Maternal mortality, United States and Canada, 1982–1997.
        Birth. 2000; 27: 4-11
        • Chang J.
        • Elam-Evans L.D.
        • Berg C.J.
        • Herndon J.
        • Flowers L.
        • Seed K.A.
        • et al.
        Pregnancy-related mortality surveillance—United States, 1991–1999.
        MMWR Surveill Summ. 2008; 52: 2-8
        • The Confidential Enquiry into Maternal and Child Health (CEMACH)
        Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003–2005.
        in: Lewis G. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. CEMACH, London2007
      1. Maternal mortality in 2005.
        Estimates developed by WHO, UNICEF, UNFPA and The World Bank. World Health Organization, WHO Press, Geneva2007 (Available at, Accessed April 9, 2010)
        • Turner L.A.
        • Cyr M.
        • Kinch R.A.H.
        • Liston R.
        • Kramer M.S.
        • Fair M.
        • et al.
        Maternal Mortality and Morbidity Study Group of the Canadian Perinatal Surveillance System. Under-reporting of maternal mortality in Canada: a question of definition.
        Chronic Dis Can. 2002; 23: 22-30
        • Stewart D.E.
        A broader context for maternal mortality.
        CMAJ. 2006; 174: 302-303
        • Wen S.W.
        • Huang L.
        • Liston R.M.
        • Heaman M.
        • Baskett T.F.
        • Rusen I.D.
        • et al.
        Maternal Health Study Group, Canadian Perinatal Surveillance System. Severe maternal morbidity in Canada, 1991–2001.
        CMAJ. 2005; 173: 759-763
        • Zwart J.J.
        • Richters J.M.
        • Ory F.
        • deVries J.I.P.
        • Bloemenkamp K.W.
        • van Roosmalen J.
        Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371,000 pregnancies.
        BJOG. 2008; 115: 842-850
        • Callaghan W.M.
        • Berg C.J.
        Pregnancy-related mortality among women age 35 years and older, United States, 1991–1997.
        Obstet Gynecol. 2003; 102: 1015-1021
        • Baskett T.F.
        • Sternadel J.
        Maternal intensive care and near-miss mortality in obstetrics.
        Br J Obstet Gynaecol. 1998; 105: 981-984
        • Baskett T.F.
        • O’Connell C.M.
        Severe obstetric morbidity: a 15-year population-based study.
        J Obstet Gynaecol. 2005; 25: 7-9
        • Baskett T.F.
        O’Connell CM.
        Maternal critical care in obstetrics: J Obstet Gynaecol Can. 2009; 31: 218-221
        • Murphy C.
        • Murad K.
        • Deane R.
        • Byrne B.
        • Geary M.P.
        • McAuliffe F.M.
        Severe maternal morbidity for 2004–2005 in three Dublin maternity hospitals.
        Eur J Obstet Gynecol Reprod Biol. 2009; 143: 34-37
      2. World Health Organization. International classification of diseases. Available at: Accessed April 9, 2010.

        • Penney G.
        • Brace V.
        Near miss audit in obstetrics.
        Curr Opin Obstet Gynecol. 2007; 19: 145-150
        • Vincent J.L.
        • Moreno R.
        • Takala J.
        • Willatts S.
        • De Mendonça A.
        • Bruining H.
        • et al.
        The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
        Intensive Care Med. 1996; 22: 707-710