THE rate of maternal death in Ireland is double the official figure.
The official maternal death rate, based on Central Statistics Office (CSO) figures, is four per 100,000 births and it has been hailed as one of the best in the world.
But a new report from Maternal Death Enquiry (MDE) Ireland says the true maternal death rate is eight per 100,000 births if internationally recognised criteria are applied.
The CSO relies solely on death certificates when compiling information, but MDE Ireland, which is funded by the HSE, gets information from different sources including hospitals, Coroners' Courts and public health nurses. MDE Ireland, overseen by doctors and midwives, was set up in 2009 to carry out confidential enquiries into maternal deaths.
The report, which covers 2009 to 2011, found that 25 women who attended maternity hospitals here died during that time. The CSO figures missed 20 of those deaths.
The rate of eight per 100,000 births was based on 12 direct and indirect maternal deaths in 2009 and 2010. The CSO recorded just four direct maternal deaths in those two years.
The maternal mortality rate of eight per 100,000 puts Ireland behind a number of countries such as Norway, which it previously outranked in World Health Organisation tables, but still ahead of the UK, which has a rate of 11.39 deaths per 100,000.
Dr Michael O'Hare, an obstetrician in Newry who chaired the working group overseeing the report, told the Irish Independent: "The CSO was missing a lot of deaths. Ireland still compares very well with other European countries but this report flags room for improvement."
None of the women died from septicaemia, the blood poisoning that is believed to have caused the death of Savita Halappanavar. Two of the women took their own lives while six died directly as a result of the complications of their pregnancy.
The women who died directly as a result of their pregnancy suffered from different conditions, including three who had a fatal blood clot. Another suffered an obstetric emergency in which amniotic fluid entered the blood stream, triggering a heart and lung collapse.
Another died due to a uterine rupture and another had multi-organ failure due to HELLP syndrome, a life-threatening pregnancy complication.
There were 13 "indirect" maternal deaths, related to a pre-existing illness or a condition that the woman developed during the pregnancy.
Two of these women died from suicide, five were due to heart conditions and two were killed by swine flu.
Two were linked to the complications of epilepsy, one was lung disease and another suffered a fatal oesophageal bleed.
The third category relates to "coincidental deaths", which refer to tragic circumstances that happen to occur during the woman's pregnancy.
Among the six coincidental deaths, two women had cancer, another passed away after a traffic accident and another had lymphoma, a form of cancer, and two more deaths were linked to substance abuse.