Perinatal Indicator: Maternal Mortality
Definition
The death of a woman while pregnant, or within one year of pregnancy. The World Health Organization includes in its statistics deaths related to, or aggravated by, the pregnancy or its management, but not accidental deaths. The leading causes of pregnancy-related maternal mortality are embolism, hemorrhage, preeclampsia or eclampsia, infection, and cardiac disease.
Why Does This Matter?
Maternal mortality is a sentinel event in assessing the quality of the healthcare system as a whole. In California, maternal deaths tripled between 1996 and 2006, from 5.6 per 100,000 live births, to 16.9 per 100,000. This is four times higher than the national Healthy People 2010 goal of 4.3 per 100,000. No one can pinpoint with certainty the reasons for this rapid and troubling rise. California’s rates ranged from 5.6 to 10.7 deaths per 100,000 live births, which is consistent with the overall U.S. rate. But by 2006, the California rate had surged to approximately 17 deaths per 100,000 live births. Although the definition of maternal mortality was expanded in 1998 to include all maternal deaths up to one year following birth, this does not account for the persistent rise in maternal mortality rates.
Disparities
For the last 50 years, African American women in the U.S. have experienced a three-to-four times higher mortality rate as a result of pregnancy and birth complications than white women. This rate appears to be independent of age, education, or the number of children they have had. In 2006, African American women in California were more than three times as likely to die from pregnancy-related causes as white women. Factors linked to an increased risk for maternal mortality include being 35 or older, less educated, obesity, and lacking adequate prenatal care. Among women whose pregnancies resulted in a live birth, the risk of pregnancy-related death increased after 20 weeks of pregnancy, and with the birth of a fifth child. The risk is also higher in both the first 12 weeks of pregnancy and after the 23rd week. A recent report showed that cesarean delivery was 10 times more likely than vaginal delivery to result in the death of the mother. Eighty-five percent of maternal deaths were unrelated to any preexisting medical condition, meaning that the vast majority of these pregnancies were originally considered low-risk.
|
For further information, please read the LA Best Babies Network Perinatal Scorecard
Year
|
Los Angeles County
|
California
|
||||
Deaths
|
Rate per 100,000 live births
|
95% Confidence Interval
|
Deaths
|
Rate per 100,000 live births
|
95% Confidence Interval
|
|
1997
|
20
|
12.3
|
11.8-12.9
|
45
|
8.6
|
8.3-8.8
|
1998
|
14
|
8.8
|
8.4-9.3
|
34
|
6.5
|
6.3-6.7
|
1999
|
14
|
9.0
|
8.5-9.4
|
43
|
8.3
|
8.1-8.5
|
2000
|
19
|
12.1
|
11.5-12.6
|
21
|
4.0
|
3.8-4.1
|
2001
|
20
|
13.0
|
12.5-13.6
|
54
|
10.2
|
10.0-10.5
|
2002
|
25
|
16.5
|
15.9-17.2
|
56
|
10.6
|
10.3-10.9
|
2003
|
21
|
13.8
|
13.2-14.4
|
82
|
15.2
|
14.8-15.5
|
2004
|
26
|
17.2
|
16.5-17.8
|
74
|
13.6
|
13.3-13.9
|
2005
|
22
|
14.6
|
14.0-15.2
|
92
|
16.8
|
16.4-17.1
|
2006
|
28
|
18.4
|
17.8-19.1
|
108
|
18.9
|
18.9-19.6
|
2007
|
22
|
14.5
|
13.9-15.1
|
80
|
13.8
|
13.8-14.
|
Sources: Los Angeles County Department of Public Health, Maternal, Child, and Adolescent Health Programs, Perinatal Health Indicators Los Angeles County Report (2007). California Department of Health Services, Center for Health Statistics, Vital Statistics, 2007. US rates extracted from the California Department of Public Health Birth Master Files 1991-2006. Two different types of ICD-9 death classification was used prior to 1998 to calculate death rates, and ICD-10 codes were used post 1998. |
Pregnancy, Childbirth, and Puerperium Deaths by Race/Ethnicity, LA County (2007) |
Race/Ethnicity
|
Number of Deaths
|
Rate per 100,000 population
|
Population
|
Hispanic
|
11
|
0.5
|
2,393,468
|
White
|
1
|
0.1
|
1,500,823
|
African American
|
7
|
1.5
|
477,832
|
American Indian
|
1
|
6.4
|
15,534
|
Asian
|
2
|
0.3
|
706,218
|
Pacific Islander
|
0
|
0
|
14,370
|
Two or More Races
|
0
|
0
|
90,380
|
LA County
|
5,198,625
|
|
Source: California Department of Health Services, Center for Health Statistics, Vital Statistics, 2007 |
Resources:California Pregnancy-Associated Mortality Review (CA-PAMR) 2011