title: Anesthesia-related maternal mortality in the United States: 1979-2002.
abstract: OBJECTIVE
  To examine 12 years of anesthesia-related maternal deaths from 1991 to 2002 and compare them with data from 1979 to 1990, to estimate trends in anesthesia-related maternal mortality over time, and to compare the risks of general and regional anesthesia during cesarean delivery.
  
  
  METHODS
  The authors reviewed anesthesia-related maternal deaths that occurred from 1991 to 2002. Type of anesthesia involved, mode of delivery, and cause of death were determined. Pregnancy-related mortality ratios, defined as pregnancy-related deaths due to anesthesia per million live births were calculated. Case fatality rates were estimated by applying a national estimate of the proportion of regional and general anesthetics to the national cesarean delivery rate.
  
  
  RESULTS
  Eighty-six pregnancy-related deaths were associated with complications of anesthesia, or 1.6% of total pregnancy-related deaths. Pregnancy-related mortality ratios for deaths related to anesthesia is 1.2 per million live births for 1991-2002, a decrease of 59% from 1979-1990. Deaths mostly occurred among younger women, but the percentage of deaths among women aged 35-39 years increased substantially. Delivery method could not be determined in 14%, but the remaining 86% were undergoing cesarean delivery. Case-fatality rates for general anesthesia were 16.8 per million in 1991-1996 and 6.5 per million in 1997-2002, and for regional anesthesia were 2.5 and 3.8 per million, respectively. The resulting risk ratio between the two techniques for 1997-2002 was 1.7 (confidence interval 0.6-4.6, P=.2).
  
  
  CONCLUSIONS
  Anesthetic-related maternal mortality decreased nearly 60% when data from 1979-1990 were compared with data from 1991-2002. Although case-fatality rates for general anesthesia are falling, rates for regional anesthesia are rising.
  
  
  METHODS
  II.
authors.affiliation: From the Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado; the Centers for Disease Control and Prevention, Atlanta, Georgia; the Oregon Anesthesiology Group, Portland, Oregon; and the Department of Anesthesiology, University of Florida School of Medicine, Gainesville, Florida.
authors.forename: Joy L
authors.initials: JL
authors.lastname: Hawkins
authors.forename: Jeani
authors.initials: J
authors.lastname: Chang
authors.forename: Susan K
authors.initials: SK
authors.lastname: Palmer
authors.forename: Charles P
authors.initials: CP
authors.lastname: Gibbs
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000401:mortality; D000768:Anesthesia, General / Q000401:mortality; D000773:Anesthesia, Obstetrical / Q000401:mortality*; D002585:Cesarean Section / Q000401:mortality; D005260:Female; D006801:Humans; D063130:Maternal Death / Q000639:trends*; D011247:Pregnancy; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult