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[Comment] Classification of maternal deaths: where does the chain of events start?

In several countries, confidential enquiry into maternal deaths, combined with rigorous classification, has become a valued method to improve the quality of maternity care. The death of Mrs X (panel) is a case of maternal mortality—ie, “the death of a woman while pregnant or within 42 days of termination of pregnancy…from any cause related to or aggravated by the pregnancy or its management”.1 However, who would predict that her underlying cause of the death would be classified differently, depending on the country where she died?