Examining the impact of introducing ICD-MM on observed trends in maternal mortality rates in the UK 2003-13
Detailed national surveillance of maternal deaths has been carried out in the UK for over 60 years, seeking reports of deaths of women during or in the six weeks after pregnancy from multiple sources including primary and secondary care physicians, midwives, pathologists and coroners, as well as routine death certification. Causes of maternal death were classified into direct and indirect causes using a standard definition. However, the causes of maternal death are now classified internationally according to ICD-MM and one significant change with the introduction of ICD-MM in 2012 was the reclassification of maternal suicide from the indirect group to the direct group. This has led to concerns about the impact of this reclassification on calculated mortality rates. The aim of this analysis is to examine the trends in maternal deaths in the UK over the past 10 years, and to investigate the impact on the observed rates of reclassification using ICD-MM.