Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by Physicians, National and International Maternal Death Review Committees

Table 1 Pregnancy-related deaths lacking consensus among maternal death review (MDR) committees whether to classify as maternal deaths

Case number	Gestational age	Case description; cause of death	Classified as a maternal death by MDR committee of
Case number	Gestational age	Case description; cause of death	Suriname	Jamaica	Netherlands
Doubt in classification of suicide in early pregnancy
1	Unknown	Gramoxone^a auto-intoxication	No	Yes	No
2	7 weeks	Gramoxone^a auto-intoxication	No	Yes	Yes
3	9 weeks	Gramoxone^a auto-intoxication	No	Yes	Yes
Doubt regarding evidence of pregnancy
4	N/A	Following a curettage, chest pain and dyspnea developed. Curettage pathology report showed no evidence of pregnancy	No	No	Yes
5	N/A	Died at home from unknown cause. Verbal autopsy with family: early pregnancy. Examination: no fundal height palpable, but peripheral edema of both feet	Yes	Yes	No
6	N/A	Died in transit to hospital. Patient complained of abdominal pain, vaginal blood loss and chest pain. Verbal autopsy with family: could be pregnant	No	Yes	Yes
Doubt whether the death was maternal or coincidental
7	25 weeks	Severe burn wounds after explosion	No	No	Yes
8	29 weeks	Sepsis, meningoencephalitis/cerebral abscess	Yes	Yes	No
9	34 days postpartum	Sepsis with symptoms of high fever and diarrhea	Yes	No	Yes
10	35 days postpartum	Normal delivery. Cause of death unknown	No	Yes	Yes
Doubt in classification of maternal death of a local resident in another country
11	29 weeks	Admitted in a Surinamese hospital with a severe sickle cell crisis. Ten days after discharge she died in neighboring French Guyana	No	Yes	No

^aGramoxone is the tradename of paraquat, a contact herbicide, highly toxic to humans

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