Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the ‘migration three delays’ model

Table 2 Suboptimal factors associated with maternal death by cause of death in Sweden 1988–2010

Causes of death	Total			Foreign-born			Swedish-born
	n = 73	Cases with suboptimal factors (major + minor)		n = 25	Cases with suboptimal factors (major + minor)		n = 48	Cases with suboptimal factors (major + minor)
Direct	37	28	(20 + 8)	16	14	(11 + 3)	21	14	(9 + 5)
AFE¹	7	5	(0 + 5)	2	2	(0 + 2)	5	3	(0 + 3)
Genital sepsis	5	4	(3 + 1)	2	1	(1 + 0)	3	3	(2 + 1)
VTE²	5	3	(3 + 0)	2	1	(1 + 0)	3	2	(2 + 0)
Pre-eclampsia³	4	4	(3 + 1)	2	2	(1 + 1)	2	2	(2 + 0)
Surgery⁴	4	4	(4 + 0)	3	3	(3 + 0)	1	1	(1 + 0)
Ectopic pregnancy	3	2	(1 + 1)	0	0		3	2	(1 + 1)
Haemorrhage⁵	2	2	(2 + 0)	2	2	(2 + 0)	0	0
Other direct⁶	7	4	(4 + 0)	3	3	(3 + 0)	4	1	(1 + 0)
Indirect	35	23	(16 + 7)	9	8	(4 + 4)	26	15	(12 + 3)
Cardiovascular⁷	21	15	(8 + 7)	5	5	(1 + 4)	16	10	(7 + 3)
Non-genital sepsis	6	6	(6 + 0)	3	3	(3 + 0)	3	3	(3 + 0)
CNS⁸	6	0		1	0		5	0
Other indirect⁹	2	2	(2 + 0)	0	0		2	2	(2 + 0)
Unclear ¹⁰	1	0		0	0		1	0

¹Amniotic fluid embolism.
²Venous thromboembolism.
³Pre-eclampsia, eclampsia, HELLP syndrome.
⁴Complication of caesarean section (n = 2), complication of anaesthesia (n = 2).
⁵Cervix rupture (n = 1), postpartum haemorrhage (n = 1).
⁶Acute fatty liver of pregnancy (n = 1), peripartum cardiomyopathy (n = 2), anaemia (n = 1), unclear cause of death assessed as direct by the audit group (n = 3).
⁷Myocarditis (n = 3), myocardial infarction (n = 4), arrthymia/SADS (sudden arrhythmic death syndrome) (n = 3), aortic aneurysm (n = 8), rupture of splenic artery (n = 1), rheumatic valve disease (n = 1), congenital heart disease (n = 1).
⁸Central nervous system; intracranial haemorrhage (n = 5), epilepsy (n = 1).
⁹Pulmonary oedema (n = 1), ileus (n = 1).
¹⁰Assessed as a maternal death, however it is unclear if it was direct or indirect.

ISSN: 1471-2393