Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery

Received 6 July 2007; received in revised form 10 December 2007; accepted 3 March 2008. published online 06 May 2008.

Refers to article:

Maternal death in the 21st century: Clark et al
Gil Gross, Roxane Rampersad, Gladys Tse, Christy Scifres, Beth Lewkowski, Tim Chrusciel
American Journal of Obstetrics & Gynecology
July 2008 (Vol. 199, Issue 1, Pages 91-92)
Abstract | Full Text | Full-Text PDF (66 KB)

Objective

We sought to examine etiology and preventability of maternal death and the causal relationship of cesarean delivery to maternal death in a series of approximately 1.5 million deliveries between 2000 and 2006.

Study Design

This was a retrospective medical records extraction of data from all maternal deaths in this time period, augmented when necessary by interviews with involved health care providers. Cause of death, preventability, and causal relationship to mode of delivery were examined.

Results

Ninety-five maternal deaths occurred in 1,461,270 pregnancies (6.5 per 100,000 pregnancies.) Leading causes of death were complications of preeclampsia, pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1 death was seen from placenta accreta. Twenty-seven deaths (28%) were deemed preventable (17 by actions of health care personnel and 10 by actions of non-health care personnel). The rate of maternal death causally related to mode of delivery was 0.2 per 100,000 for vaginal birth and 2.2 per 100,0000 for cesarean delivery, suggesting that the number of annual deaths resulting causally from cesarean delivery in the United States is about 20.

Conclusion

Most maternal deaths are not preventable. Preventable deaths are equally likely to result from actions by nonmedical persons as from provider error. Given the diversity of causes of maternal death, no systematic reduction in maternal death rate in the United States can be expected unless all women undergoing cesarean delivery receive thromboembolism prophylaxis. Such a policy would be expected to eliminate any statistical difference in death rates caused by cesarean and vaginal delivery.

Key words: cesarean delivery, maternal death, quality of care

a Hospital Corporation of America, Nashville, TN

b Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.

Reprints: Steven L. Clark, MD, Medical Director, Women and Newborns Clinical Program, Hospital Corporation of America, St Mark's Women's Pavillion, 1140 East 3900 South, Salt Lake City, UT 84124.

Cite this article as: Clark SL, Belfort MA, Dildy GA, et al. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008;199:36.e1-36.e5.

PII: S0002-9378(08)00268-8

doi:10.1016/j.ajog.2008.03.007

14 of 52