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5: Hospital maternal mortality rates are falling, overall maternal mortality still rises: Implications for forward movement

      Objective

      In recent years, both the SMFM and ACOG have introduced programs to address the problem of maternal mortality in the United States. To date, however, the actual impact of these programs on maternal deaths in the U.S. remains unclear. To examine trends in U.S. maternal mortality by place of death. We hypothesized that differences in place of death mortality ratios may allow some distinction between deaths related to medical performance and those more closely related to social, cultural or environmental issues.

      Study Design

      We conducted a retrospective, cross-sectional study for the years 2003 to 2016 using Multiple Cause-of-Death Mortality Data provided by the CDC and Natality Data provided by National Vital Statistics System of the National Center for Health Statistics. Data related to place of death, cause of death, race/ethnicity and age at the time of death was analyzed.

      Results

      Maternal mortality ratio attributed to place of death is demonstrated in Figure 1. Inpatient MMR fell by 20% over the study period, from 53/100,000 to 44/100,000 live births. (p< 0.0001). Maternal deaths in an outpatient facility or emergency room demonstrated a similar (24%) decline over the study period (p< 0.0001). There was a significant increase in mortality in other settings, particularly within the descendant’s home with a doubling in MMR over this time period. (Figure 1).

      Conclusion

      Against a background of stable or rising U.S. maternal mortality ratios, stratification of such deaths by place of death demonstrates a significant and progressive decline in inpatient, outpatient and emergency department deaths. Current trends in maternal mortality in the U.S. are driven by factors other than the quality of medical care which may be improving, possibly related to ongoing efforts by the SMFM and ACOG to prevent maternal death. Futureprogress in lowering maternal mortality in the U.S. will require successfully addressing social, cultural and financial issues beyond the direct control of the medical community.
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