The way to move beyond the numbers: the lesson learnt from the Italian Obstetric Surveillance System

Regional Maternal Mortality Working Group

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries.

METHODS: All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death.

FINDINGS: A total of 106 maternal deaths among 1 455 545 live births have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes.

CONCLUSIONS: A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for preventing avoidable maternal deaths.

Original languageEnglish
Pages (from-to)363-370
Number of pages8
JournalAnnali dell'Istituto Superiore di Sanita
Issue number4
Publication statusPublished - Dec 19 2019


  • Abortion, Induced/mortality
  • Adult
  • Cause of Death
  • Cesarean Section/mortality
  • Death Certificates
  • Emergencies
  • Emigrants and Immigrants
  • Female
  • Humans
  • Incidence
  • Italy/epidemiology
  • Maternal Mortality
  • Medical Record Linkage
  • Population Surveillance/methods
  • Pregnancy
  • Pregnancy Complications/mortality
  • Prospective Studies
  • Puerperal Disorders/mortality
  • Reproductive Techniques, Assisted/mortality


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