The Nordic Maternal mortality group and the Nordic Obstetric Surveillance Study (NOSS) collaboration
The Nordic maternal mortality group and the NOSS collaboration comprises clinicians in obstetrics and gynecology, anesthesiology/intensive care, general practice and epidemiologists in the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. The Nordic maternal mortality teams conduct enhanced surveillance and confidential enquiries into maternal deaths by combining national Cause of Death registries, the National Medical Birth Registries and clinical information from national confidential enquiries and then discuss these national findings in joint Nordic meetings and publish joint learning reports. The NOSS teams conduct enhanced obstetric surveillance of severe maternal morbidity by combining data from the National Medical Birth Registries, National patient registries, and including directly collected clinical information from medical records in each country and then combine the results. Only aggregated information is shared across countries due to confidentiality regulations.
The cross-national collaboration is essential to provide robust information about rare and severe morbidities and maternal deaths, and also to compare differences in clinical care across countries.
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 of the national monitoring and confidential enquiries into maternal deaths
- Estimating the maternal mortality ratio (MMR) through record-linkage procedures between Medical Birth Registries, Cause of Death Registry, (Hospital Discharge Database?) and direct notification
- Identifying the main causes of maternal mortality through incident reporting and Confidential Enquiries
Aims of the severe maternal morbidity activities:
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Undertake research projects and interventions targeting primary causes of maternal mortality and severe morbidity.
- Identify critical clinical-care and organizational challenges susceptible to improvement.
- Formulate evidence-based recommendations for clinical practice.
- Develop training to healthcare professionals on the leading causes of maternal mortality and severe morbidity and contribute to national management guidelines.
- Assess the impact of implemented measures and refining objectives accordingly.
Previous studies
NOSS has conducted prospective population-based research projects on the following conditions:
- severe maternal morbidity due to obstetric haemorrhage, emergency peripartum hysterectomy, abnormally invasive placenta, uterine rupture.
- Severe maternal morbidity with previous cesarean section, emergency peripartum hysterectomy
- severe maternal morbidity due to sepsis, eclampsia, amniotic fluid embolism, and spontaneous hemoperitoneum in pregnancy
- SARS-CoV-2 infection during pregnancy, childbirth, and postpartum.
Current studies
- Severe morbidity and mortality from eclampsia- follow-up of previous NOSS/Mortality results
- Intensive care admission of pregnant women and maternal deaths due to COVID-19; incidence and medical treatment provided in 2020-2021
- Severe maternal morbidity due to cardiac arrest, hysterectomy and treatment for abnormally invasive placenta
Funding: The Nordic collaborations on maternal mortality and severe maternal morbidity have received some funding support from the Nordic Federation of Societies of Obstetrics and Gynecology, in addition to funding from various bodies for the national projects.
National contact persons
Maternal mortality
Denmark: Anna Aabakke, aabakke@gmail.com
Marianne Johansen, marianne.johansen@regionh.dk
Finland: Outi Äyräs, outi.ayras@hus.fi
Iceland: Eva Jonasdottir, evajonas@gmail.com
Norway: Lill Nyfløt, Lill.Trine.Nyflot@vestreviken.no
Sweden: Lisa Paren, lisa.paren@vgregion.se
Hanna Åmark, hanna.amark@regionstockholm.se
Severe maternal morbidity
Denmark: Anna Aabakke, aabakke@gmail.com
Finland: Outi Äyräs, outi.ayras@hus.fi
Iceland: Eva Jonasdottir, evajonas@gmail.com
Norway: Hilde Engjom, hildemarie.engjom@fhi.no
Sweden: Teresia Svanvik, maria-teresia.svanvik@gu.se
