BACKGROUND AND PURPOSE:

• Approximately 700 women die every year in the U.S. from pregnancy-related complications
  • There is a significant racial/ethnic disparity in pregnancy-related mortality
• Petersen et al. (MMWR Morb Mortal Wkly Rep, 2019) used data from the CDC’s national Pregnancy Mortality Surveillance System and data from 13 state maternal mortality review committees to
  • Assess the timing and characteristics of pregnancy-related deaths
  • Determine the percentage of pregnancy-related deaths that were preventable
  • Identify factors that contributed to the deaths

METHODS:

• Data review and analysis
• Data sets
  • CDC’s national Pregnancy Mortality Surveillance System (PMSS) for 2011–2015
  • 13 state’s maternal mortality review committees (MMRCs) data on pregnancy-related deaths during 2013–2017
• CDC data analysis
  • Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births; PRMRs) were calculated overall and by sociodemographic characteristics
  • The distribution of pregnancy-related deaths by timing relative to the end of pregnancy was calculated
  • Leading causes of death was calculated
• MMRCs data analysis of
  • Preventability
  • Factors contributing to pregnancy-related deaths
  • MMRC-identified prevention strategies to address contributing factors

RESULTS:

• From 2011-2015, a total of 3,410 pregnancy-related deaths occurred in the United States
  • The national pregnancy-related mortality ratio (PRMR) was 17.2 per 100,000 live births
• Non-Hispanic black (black) women and American Indian/Alaska Native women had the highest PRMRs, which were 3.3 and 2.5 times as high, respectively, as non-Hispanic white (white) women
  • PRMR for Non-Hispanic black (black) women: 42.8
  • PRMR for American Indian/Alaska Native women: 32.5
  • PRMR for white women: 13.0
• Timing of death
  • Timing of death was known for 87.7% (2,990) of pregnancy-related deaths
    • 31.3% occurred during pregnancy
    • 16.9% occurred on the day of delivery
    • 18.6% occurred 1–6 days postpartum
    • 21.4% occurred 7–42 days postpartum
    • 11.7% occurred 43–365 days postpartum
• Causes of death
  • Leading were cardiovascular conditions, infection, and hemorrhage
• Cause of death varied by timing
  • Amniotic fluid embolism: Day of delivery or within 6 days postpartum
  • Hypertensive disorders: Approximately 60% of deaths between 0–6 days postpartum
  • Cerebrovascular accidents: 1–42 days postpartum
  • Cardiomyopathy: Between 43–365 days postpartum
• Preventability
  • ~60% of pregnancy-related deaths were determined to be preventable
    • Did not differ significantly by race/ethnicity or timing of death
• Contributing factors could be categorized at the community, health facility, patient, provider, and system levels
• Prevention strategies include improving access to, coordination of, and delivery of quality care

CONCLUSION:

• Pregnancy-related deaths occurred at multiple time points: during pregnancy, around the time of delivery, and up to 1 year postpartum
• Leading causes of pregnancy-related deaths varied by timing of death
• Approximately three in five pregnancy-related deaths were preventable
• In the discussion, the authors state

No single intervention is sufficient; reducing pregnancy-related deaths requires reviewing and learning from each death, improving women’s health, and reducing social inequities across the life span, as well as ensuring quality care for pregnant and postpartum women

Learn More – Primary Sources:

Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017

Related ObG Topics:

Maternal Near-Misses: An Investigation of Incidence and Causes

Postpartum Hemorrhage – Medications to Treat Uterine Atony 

Postpartum Hemorrhage Prophylaxis: The World Health Organization Recommendations

SMFM & CMQCC Guidelines: Making the Diagnosis of Sepsis in Pregnancy

SMFM & CMQCC Guidelines: Management of Sepsis in Pregnancy

Peripartum Cardiomyopathy: Definitions, Diagnosis and Management

Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines