Maternal Mortality in the Twenty-First Century

https://doi.org/10.1016/j.ogc.2018.01.004Get rights and content

Section snippets

Key points

  • Maternal mortality plagues much of the world, with 303,000 maternal deaths in 2015. This number represents a global maternal mortality ratio of 216 maternal deaths per 100,000 live births.

  • The World Health Organization has created a goal to decrease the global maternal mortality ratio to 70 maternal deaths per 100,000 live births by the year 2030.

  • The maternal mortality ratio is higher in the United States than in any other developed nation and has increased over the last several years.

Maternal mortality in the United States

To understand current maternal mortalities and trends in the United States, it is important to recognize the terminology that is used. There are several terms, each with a slightly different definition and resultant different rates of maternal mortality. The use of multiple terms often leads to differing reports of maternal mortality in both popular and scientific literature. Current frequently used terminology and definitions include the following:

  • Pregnancy-Related Death (Centers for Disease

Racial disparities and maternal mortality in the United States

In an analysis of pregnancy-related death in the United States from 2006 to 2010, significant racial disparities in pregnancy-related mortality ratios were demonstrated.15 It was found that a significantly higher proportion of non-Hispanic black women experienced pregnancy-related death compared with non-Hispanic white women. Although women in all racial groups were found to be at increased risk of pregnancy-related death with increasing age, this finding was particularly pronounced among

Preventability

Multiple studies have demonstrated that almost half of pregnancy-related deaths in the United States are preventable.22, 23 In a retrospective study of maternal deaths in North Carolina, 108 pregnancy-related deaths were reviewed by the North Carolina Pregnancy-Related Mortality Review Committee.22 They found that 40% of pregnancy-related deaths were potentially preventable and that preventability varied by cause. They reported that 93% of hemorrhage-related deaths, 60% of hypertension-related

Severe maternal morbidity

Like maternal mortality, severe maternal morbidity is increasing in the United States.11, 27, 28 It is currently estimated to affect at least 50,000 women per year with an occurrence of 0.5% to 1.3% of pregnancies in the United States.27, 28 Because severe maternal morbidity lies within a continuum ranging from healthy pregnancy to death, efforts to identify and prevent causes of severe maternal morbidity are thought to ultimately decrease morbidity and, hence, maternal mortality.22, 24, 25, 26

Strategies for reduction of maternal mortality

The CDC established the pregnancy mortality surveillance system in 1986, which collects data from 52 reporting areas (50 states, New York City, and Washington, DC).9 The CDC requests that these areas voluntarily submit copies of death certificates for all women who died during pregnancy or within 1 year of pregnancy along with copies of the matching birth or fetal death certificates.9 This information yields valuable epidemiologic data regarding causes and risk factors associated with maternal

Summary

Despite improvements in rates of global maternal mortality over the last century, it remains a problem that continues to plague much of the world. Rates of maternal mortality are increasing in the United States with significant racial disparities that disproportionately affect non-Hispanic black women. Up to half of pregnancy-related deaths in the United States have been found to be preventable.14, 21, 22 There are strategies that have been shown to reduce the rates of severe maternal morbidity

First page preview

First page preview
Click to open first page preview

References (42)

  • L.E. Shields et al.

    Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety

    Am J Obstet Gynecol

    (2015)
  • I. Loudon

    Death in childbirth: an international study of maternal care and maternal mortality, 1800–1950

    (1992)
  • Centers for Disease Control and Prevention (CDC)

    Healthier mothers and babies

    MMWR Morb Mortal Wkly Rep

    (1999)
  • UN General Assembly. United Nations Millennium Declaration, Resolution Adopted by the General Assembly; 2000;...
  • Strategies toward ending preventable maternal mortality (EPMM)

    (2015)
  • Organisation for economic co-operation and development. Available at:...
  • Centers for Disease Control and Prevention. Available at:...
  • World Health Organization, Health statistics and information systems. Available at:...
  • A.P. MacKAy et al.

    Changes in pregnancy mortality ascertainment: United States, 1999-2005

    Obstet Gynecol

    (2011)
  • A. Moaddab et al.

    Health care disparity and state-specific pregnancy-related mortality in the United States, 2005-2014

    Obstet Gynecol

    (2016)
  • A.A. Creanga et al.

    Pregnancy-related mortality in the United States, 2006-2010

    Obstet Gynecol

    (2015)
  • Cited by (0)

    The authors have no financial disclosures.

    View full text