Objective To compare maternal mortality in eight countries with enhanced surveillance systems. Design Descriptive multicountry population based study. Setting Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia. Population 297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18). Outcome measures Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country’s office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women’s origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated. Results Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy. Conclusions Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.

Background: Sexual health problems are common. Therefore, training in sexual health is relevant for the clinical practice of trainees and early-career specialists in several specialties who deal with patients with sexual health problems. However, little is known about how sexual health training is provided across countries and specialties. Aim: To assess (i) sexual health training during postgraduate training programs in psychiatry, obstetrics and gynecology, urology, and endocrinology across Europe; (ii) the confidence of trainees and early-career specialists in dealing with patients with sexual health problems; and (iii) their need for further training in sexual health during postgraduate training programs. Methods: The study was based on a collaboration among European societies of trainees in these 4 specialties. An online survey was developed and conducted from January 2015 through June 2016. Main Outcome Measures: Self-reported questionnaire. Results: We collected 366 completed surveys from 40 countries. Sexual health training was considered an important or very important part of specialty training by 78.7% of participants. Overall, 62.3% of participants had not received any training in sexual health. Especially in obstetrics and gynecology, the large majority did not have training in sexual health (82.8%), followed by psychiatry (59.8%), urology (58.4%), and endocrinology (56.1%). There were statistically significant differences among specialties in the confidence of participants in managing patients with sexual health problems. In general, trainees and early-career specialists who had received sexual health training felt more confident in dealing with patients with gender dysphoria (P = .011), need for sexual therapy (P = .0004), paraphilic disorders (P = .0003), and sexual dysfunction (P = .0017). Conclusions: Trainees and early-career specialists found sexual health training important for their future medical practice; however, less than half received it during their postgraduate training. Participants felt more confident in managing patients with sexual health problems when sexual health training was included in the postgraduate training program.

Objective: Analysis of life-threatening maternal morbidities, the condition of which required subsequent treatment in Intensive Care Units (ICU) in the Slovak Republic in the years 2012–2020. Methodology: Retrospective analysis of 655 identified cases of mothers admitted to the intensive care units out of 436,136 births. The reasons for the transport were divided into nine categories: peripartum bleeding, hypertensive diseases, thromboembolism, cardiovascular diseases, sepsis/severe infections, metabolic diseases, complications of anaesthesiology, gastroenterological problems and others. Results: The total incidence of admission to the intensive care units in the observed period was 1.5 per 1,000 births, but for mothers of Roma nationality it was 8.8 per 1,000 births. The average age of mothers was 30.7 years, while 29.7% were over 35 years old. Overweight and obesity was present by 70.4% of mothers. The most common reason for transport to the ICU (49.3%) was severe postpartum hemorrhage. The second most common cause (26.0%) was hypertensive diseases (preeclampsia, eclampsia and HELLP syndrome). The third most common cause (4.9%) was sepsis and severe maternal infections. The mortality rate of mothers admitted to the ICU was 2.3% and infant mortality of these mothers was 8.7%. Conclusion: The incidence of admission of mothers to the ICU in the monitored years was 1.5 per 1,000 births, which in international comparison ranks Slovakia among countries with a lower incidence. Key words: severe acute maternal morbidity – mother admission to the intensive care unit

Analyses of severe acute maternal morbidity in Slovakia during years 2012–2016

Objective: Analysis of maternal mortality and identification of risk factors for maternal deaths in Slovakia in the years 2007–2023. Methods: Retrospective population-based descriptive analysis of maternal mortality from 2007 to 2023 based on the International Classification of Diseases—Maternal Mortality 10th edition (ICD-MM). Selected demographic characteristics were analysed, and statistical data from official sources and the enhanced surveillance system were compared. Results: From 2007 to 2023, there were 940 351 live births and 109 maternal deaths in Slovakia, resulting in a maternal mortality ratio (MMR) of 11.6 per 100 000 live births. Indirect causes of maternal deaths predominated (52 deaths, MMR 5.5 per 100 000 live births) over direct causes (45 deaths, MMR 4.8 per 100 000 live births). The most common causes of death were cardiovascular diseases (22.0%), amniotic fluid embolism (11.0%), viral infections (10.1%), obstetrics haemorrhage (8.3%) and hypertensive disorders of pregnancy, childbirth and puerperium (8.3%). Ten (9.2%) of all deaths were coincidental. The lowest MMR was observed in women aged 20–24 years (3.8), and the highest over 35 years (28.7) per 100 000 live births. Vital maternal mortality data were underreported by 69.7% compared to enhanced surveillance system data. Conclusion: The findings highlight the critical importance of improving healthcare infrastructure, access to quality maternal care, and timely interventions to prevent maternal deaths. Addressing the underreporting of maternal deaths and ensuring accurate data collection are crucial to understanding the true scope of the issue and identifying areas for improvement.