Measuring the outcome of pregnancy in Europe: the ICM Research Standing Committee contributed crucial sessions to a meeting of the European Perinatal Epidemiology Network (EPEN) in Oxford, UK, on October 3, 2003.

The co-chairs of the ICM Research Standing Committee, Jane Sandall and Kathy Herschderfer, were instrumental in convening this meeting. The afternoon session, 'Using positive measures of health outcome for use in maternity research' was organised by Jane, with Alison Macfarlane of EPEN, and chaired by Kathy.

The first morning session focused on 'Developing indicators for monitoring reproductive and child health' and there were reports on the European Health Monitoring Programme, and from the Reprostat, CHILD and PERISTAT projects. In the next period, detailed 'Findings from the PERISTAT perinatal indicators project' were presented by members of the PERI-STAT Advisory Committee, Alison Macfarlane, Jennifer Zeitlin, Simone Buitendijk, Katherine Wildman and Sophie Alexander.

Katherine Wildman had brought together figures relating to Caesarean section (CS) from the countries of Europe. Rates varied from Greece and Italy with levels in excess of 30%, followed by the countries of the UK with slightly fewer, down to the Netherlands with the lowest rate in Europe.

Maternal mortality and morbidity

Sophie Alexander began by highlighting the well-known axiom that statistics can appear misleading. According to raw available data, the UK has the highest maternal mortality rate in Europe with 11.4 deaths per 100,000 live births. Belgium follows with 9.5 and the Netherlands with 9.0. Dr Alexander felt that this was unlikely to represent the true picture, but more probably demonstrated that these countries have clear and robust records and analysis of the data relating to maternal deaths. The UK's Confidential Enquiries into Maternal Deaths was regarded as one of the best national systems of collating and making use of the data.

Following this presentation, a delegate described an episode resulting in a maternal death, in which he had been involved. The patient was a pregnant Portuguese woman, who lived in Lichtenstein; suffering severe complications, she was referred to a hospital in Austria; unfortunately she died in the hospital, but was then transported to Switzerland for post mortem. It seemed likely that the death was registered in four European countries.

Sophie Alexander suggested that far more rigorous systems are needed in many countries. Significant data that should be recorded alongside include age of the mother, actual cause of death and mode of delivery. Race or ethnic group of the mother would also be of interest, and potentially of use in reviewing services.

Another aspect of this topic, discussed briefly, was the dramatic difference in the shape of the graphs representing maternal deaths and infant deaths respectively, set against the age of the mother. Maternal deaths curve sharply upward as age increases through late 30s and...