Belgian Obstetric Surveillance System (B.OSS) and Belgian Analysis system for Maternal Mortality (BAMM)

The Belgian Obstetric Surveillance System (B.OSS) and Belgian Analysis system for Maternal Mortality (BAMM) are Belgian surveillance systems funded by Federal Public Service of Health. B.OSS (www.b-oss.be) started its first registrations in almost all Belgian maternity units in January 2012. The objective of B.OSS is to get an accurate picture of the obstetric complications under investigation in Belgium. In 2021, the BAMM registry (www.b-oss.be/bamm) was successfully launched and primarily aimed to evaluate obstetrical care in Belgium, by the registration and analysis of individual maternal mortality cases. Hence, the overarching aim of B.OSS and BAMM is to improve maternal care and decrease maternal mortality and severe maternal morbidity in Belgium by practical recommendations based on the results.

Mission statement

To provide estimates on maternal mortality, identify key factors contributing to maternal deaths and severe morbidity, and promote targeted public health interventions to improve the quality of care during childbirth and prevent avoidable adverse outcomes.

Aims

Aligned with our mission, the objectives of B.OSS and BAMM encompass the following:

• To define the incidence of rare obstetric disorders in Belgium, to identify their risk factors, and to describe and evaluate management;
• To investigate the incidence of maternal mortality in Belgium in a prospective way, and thereby produce a more accurate estimate of the Maternal Mortality Ratio (MMR) in Belgium which is communicated to international instances;
• To identify the causes, risk factors, and contributing factors of maternal deaths by a detailed and structured analysis, firstly on a local level (hospital) and secondly on a national level (multidisciplinary team of experts);
• To compare obstetrical care in Belgium with other countries, based on rare obstetric disorders and maternal mortality registration and analysis;
• Formulating evidence-based recommendations in national guidelines to improve obstetrical care, management, and outcomes;
• Provide ongoing training to healthcare professionals on the leading causes of maternal mortality and severe morbidity.

Previous studies

B.OSS has conducted prospective population-based research projects on the following conditions:

• Severe maternal morbidity due to uterine rupture, eclampsia, spontaneous haemoperitoneum, anaphylaxis, sepsis, pulmonary embolism, COVID-19, and intrahepatic cholestasis of pregnancy;
• Peripartum hysterectomy/ embolization;
• Surgical complications of bariatric surgery in pregnancy.

Current studies

• Re-laparotomy after Caesarean section;
• General Anaesthesia for Caesarean section;
• Maternal mortality.