Maternal mortality in North Carolina: a forty-year experience

Abstract

An analysis of 67 maternal deaths from January 1, 1981, through December 31, 1985, are reported in detail and in the perspective of 3780 maternal deaths previously reviewed in North Carolina since January 1, 1946. Although the direct obstetric mortality rate has decreased 95% over the 40 years, within causal mortality groups the rates have changed variably during the past 5 years. For the first time, no deaths from obstetric infection occurred. Whereas deaths from toxemia continue to decline, those from hemorrhage, embolism, and anesthetic complications remain unchanged. Within the hemorrhage causal group, deaths from ectopic pregnancy have risen to 70%. The maternal death rate after 20 weeks' gestation is almost 10 times that associated with pregnancy interruptions. Of particular concern is the relative risk of death between the nonwhite and white patients. The North Carolina data are reviewed in the light of those in the South Atlantic region and in the nation as a whole.

PIP: An analysis of 67 maternal deaths from January 1, 1981, through December 31, 1985, are reported in detail and in the perspective of 3780 maternal deaths previously reviewed in North Carolina since January 1, 1946. During the 5-year study period, 428,891 live births and 155,498 elective abortions occurred. A total of 54 direct and indirect maternal deaths were unrelated to elective abortion (12.6: 100,000 live births) and 2 deaths succeeded 1 elective and 1 indicated abortion (1.3: 100,000 abortions). Although the direct obstetric mortality rate has decreased 95% over the 40 years, within causal mortality groups the rates have changed variably during the past 5 years. For the 1st time, no deaths from obstetric infection occurred. Whereas deaths from toxemia continue to decline, those from hemorrhage, embolism, and anesthetic complications remain unchanged. Within the hemorrhage causal group, deaths from ectopic pregnancy have risen to 70%. The maternal death rate after 20 weeks' gestation is almost 10 times that associated with pregnancy interruptions. Data from North Carolina, as well as regional and national data indicate at least a 3-fold to 4-fold greater risk of death in nonwhite women. Significant risk variations, such as the increased frequency of cardiovascular disease in the black race, are present in causal groups that cannot be explained specifically.