Reducing Maternal Mortality: Room for Improvement?

Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

French study shows hemorrhage remains the primary and often avoidable cause of maternal deaths.

Worldwide progress in reducing maternal mortality has been notable, but rising incidence of risk factors such as advanced maternal age, obesity, and cesarean delivery may hinder further improvement. Researchers analyzed death-certificate data in France from 1998 through 2007 to assess trends in risk factors for as well as causes and avoidability of maternal deaths that occurred during pregnancy or within 365 days postpartum (and related to pregnancy). During the 10-year study period, 660 maternal deaths were recorded. The overall maternal mortality ratio was nearly constant: 8.8 per 100,000 live births for 1998 through 2002 and 8.4 per 100,000 for 2003 through 2007.

Overall, the leading direct causes of death were hemorrhage (18%), amniotic fluid embolism (12%), thromboembolism (11%), and hypertensive disorders (10%). Cardiovascular conditions and cerebrovascular accidents were the leading indirect causes of death. Almost half of evaluable maternal deaths were determined to be avoidable, and >90% of deaths attributed to hemorrhage were deemed avoidable. Specific factors leading to avoidable deaths in all categories were inadequate management (e.g., undertransfusion for postpartum hemorrhage), delay in management, erroneous or missed diagnosis, and poor maternal adherence to medical advice. Neither causes of death nor prevalence of avoidable deaths changed significantly with time.

Citation(s):

Saucedo M et al. Ten years of confidential inquiries into maternal deaths in France, 1998–2007. Obstet Gynecol 2013 Oct; 122:752.