Preventability of pregnancy-related deaths: results of a state-wide review.
OBJECTIVE
Although the risk of death from complications of pregnancy in the 20th century has decreased dramatically, several lines of evidence suggest that it has not reached an irreducible minimum. To further reduce pregnancy-related mortality, we must understand which deaths are potentially preventable and the changes needed to prevent them. We sought to identify all pregnancy-related deaths in North Carolina and conduct a comprehensive review examining ways in which the number of these deaths could potentially be reduced.


METHODS
The North Carolina Pregnancy-Related Mortality Review Committee reviewed all of the 108 pregnancy-related deaths (women who died during or within 1 year of the end of pregnancy from a complication of pregnancy or its treatment) that occurred in the state in 1995-1999. For each death, the committee determined the cause of death, whether it could have been prevented, and if so, the means by which it might have been prevented.


RESULTS
Although overall, 40% of pregnancy-related deaths were potentially preventable, this varied by the cause of death. Almost all deaths due to hemorrhage and complications of chronic diseases were believed to be potentially preventable, whereas none of the deaths due to amniotic fluid embolus, microangiopathic hemolytic syndrome, and cerebrovascular accident were considered preventable. Improved quality of medical care was considered to be the most important factor in preventing these deaths. Among African-American women, 46% of deaths were potentially preventable, compared with 33% of the deaths among white women.


CONCLUSIONS
Despite the decline in pregnancy-related mortality rates, almost one half of these deaths could potentially be prevented, mainly through improved quality of medical care. In-depth review of pregnancy-related deaths can help determine strategies needed to continue making pregnancy safer.
Berg
Cynthia J
CJ
Centers for Disease Control and Prevention, Atlanta, Georgia, USA. cjb3@cdc.gov
Harper
Margaret A
MA
Atkinson
Samuel M
SM
Bell
Elizabeth A
EA
Brown
Haywood L
HL
Hage
Marvin L
ML
Mitra
Avick G
AG
Moise
Kenneth J
KJ
Callaghan
William M
WM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008423:Maternal Age; D008428:Maternal Mortality / Q000639:trends*; D016012:Poisson Distribution; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D014481:United States