Maternal mortality in Croatia from 1994 to 2023

Objective: To analyze maternal mortality trends due to complications during pregnancy, childbirth, and the postpartum period across three 10-year intervals between 1994 and 2023 in Croatia. Materials and methods: Maternal death data were retrospectively collected from the Croatian Institute of Public Health. Causes of death were classified as direct or indirect, according to the 10th Revision of the International Classification of Diseases (ICD-10). Direct, indirect, and combined maternal mortality rates were calculated and compared for each decade. Trends in indirect maternal mortality and the distribution of direct causes were analyzed. Results: During the 30-year period, 1,248,207 live births were recorded, and 90 maternal deaths occurred (maternal mortality rate 7.21/ 100,000 liveborn children). There were 37 deaths in the period 1994–2003, 38 in 2004–2013, and 15 in 2014–2023. Total maternal mortality rates were similar in 2004–2013 period compared to the previous decade, but significantly lower in 2014–2023. A significantly lower odds ratio for maternal mortality was found in 2014–2023 compared to 1994–2003. Indirect maternal mortality rates were 0.61/ 100,000 live births in 1994–2003, 4.03 in 2004–2013, and 1.14 in 2014–2023. The mean value for all three decades was 2.00/100,000 liveborn children. The leading direct causes of death were haemorrhage (24.0%), thromboembolic events (28.6%), and hypertensive disorders (24.2%). Thromboembolic events showed a non-significant increase, while the frequency of hypertensive disorders and haemorrhage related deaths remained unchanged over the years. Conclusions: The total maternal mortality rate showed significant decline over the last decade of investigation. The rate of indirect maternal mortality significantly increased over the 2004–2013 period, contrary to the rates in two remaining decades. Among direct causes of maternal deaths, thromboembolic events showed a non-significant increase over the years, while hypertensive disorders and hemorrhage remained a constant cause of maternal deaths throughout all three decades.