Italy has one of the lowest maternal mortality rates in the world. The World Bank figures suggest that Italy has had an average of four maternal deaths in pregnancy per 100,000 live births since 2004, one of the ten lowest mortality rates in the world. Italian health authorities have ordered investigations after five women died in childbirth in seven days, shocking the nation. The deaths occurred across the country between December 25 and 31, 2015.
While all appear to have explicable causes, their concentration over the holiday period has raised questions over whether hospital staffing may have been a factor and also over whether older mothers-to-be are being sufficiently monitored for warning signs of potentially fatal conditions.
In the latest case, Giovanna Lazzari, 29, already a mother of two who was eight months pregnant, died on New Year's Eve in Brescia, northern Italy, a day after coming to an emergency unit with a high fever and symptoms of gastroenteritis, revealed her partner Roberto Coppini. As her condition deteriorated, doctors attempted an emergency Cesarean but were unable to save either the mother or the fetus.
Ezio Belleri, the hospital's director general, said, "An initial review of Lazzari's treatment had not found any indication of errors. The doctors did everything that could be done. Up to now, nothing indicates that any errors were made. The cause of death had been septic shock brought on by hemorrhaging that was likely the result of an unpredictably rapid spread of a very strong bacterial infection."
Health minister Beatrice Lorenzin has dispatched experts to establish what happened in Brescia and three of the other four fatal cases. Their first report is due Monday, January 4, 2016.
Lorenzin said, "We have to understand if the recommended procedures were followed or if there were organizational deficiencies. The priority is identifying any errors and preventing other tragedies."
In two of the other cases, both of which resulted in still births, the mothers, aged 35 and 39, suffered cardiac arrest during labor, according to reports.
Anna Massignan, a 34-year-old doctor from Lonigo, near Vicenza who died on Christmas Day, succumbed after an emergency Cesarean eight months into her pregnancy, reportedly following a fall at home. Her son was delivered alive but died several hours later.
The one case not being investigated concerned a 23-year-old from Foggia in southern Italy who was approaching her due date and died suddenly at home. Doctors were able to perform a postmortem Cesarean and save her daughter.
A leading gynecologist said some of the victims may have paid the price for inadequate screening for the risk of thrombosis or heart problems emerging during the latter stages of pregnancy.
Rosalba Paesano, Professor of Gynaecological Science at Rome's La Sapienza university, said, "With preventative checks we could save so many women in the delivery room. But the health ministry does not say they are required, in reality because they cost too much. The procedures we have in place are obsolete."
Consumer group Codacons said, "It would be filing requests on Monday for prosecutors to look into whether regional authorities and the health ministry had been negligent in their instructions to hospitals regarding screening measures and preventative treatment."
Antonio Starita, medical director at Rome's San Camillo hospital, told La Stampa, "The one figure that stands out is that 35% of pregnancies in Italy involve women over 35 and, at this age, the maternal mortality risk doubles."
Starita said blocks on new hires in parts of the health system could be creating staff shortages, particularly among midwives assigned to home visits who could pick up early warning signs of problems in pregnancy.