Italy in shock over spate of childbirth deaths
Italian health authorities on Sunday ordered investigations after five women died in childbirth in seven days, shocking a nation with one of the lowest maternal mortality rates in the world.
The deaths occurred across the country between December 25 and 31.
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, according to her partner Roberto Coppini.
As her condition deteriorated, doctors attempted an emergency Cesarean but were unable to save either the mother or the foetus.
"In a few hours, I lost a baby and a unique mamma. Someone has to tell me what happened," Coppini told reporters.
"Giovanna sent me a text message during the night in which she told me she had very strong pains but that the doctors were not paying any attention to her.
"She would have been 30 on January 1. She was young and healthy."
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," he said. "Up to now, nothing indicates that any errors were made."
Belleri said the cause of death had been septic shock brought on by haemorrhaging 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.
"We have to understand if the recommended procedures were followed or if there were organisational deficiencies," Lorenzin said.
"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 labour, 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 post-mortem Cesarean and save her daughter.
A leading gynaecologist 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.
"With preventative checks we could save so many women in the delivery room," said Rosalba Paesano, Professor of Gynaecological Science at Rome's La Sapienza university.
"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," Paesano told La Repubblica.
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 percent 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 amongst midwives assigned to home visits who could pick up early warning signs of problems in a pregnancy.
According to World Bank figures, 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.