The overall maternal death rate is
not as low as it could be, according to a review of pregnancy-related
deaths in North Carolina, which suggests that about four
out of every 10 pregnancy-related deaths are potentially
preventable.
"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," investigators note in the December issue of Obstetrics
and Gynecology.
The fact that several other developed countries have
maternal mortality ratios lower than that of the US, and
that some racial and ethnic groups have higher risks of
pregnancy-related death, led lead investigator Dr. Cynthia
J. Berg and her colleagues to theorize that maternal mortality
rates could be lower than they are.
The North Carolina State Center for Health Statistics
combed through four computerized databases to identify
108 pregnancy-related deaths that occurred between 1995
and 1999. Berg and her team evaluated these cases and
concluded, based on the cause of death, that 41 cases
could have been prevented.
Their analysis showed that 90 percent of deaths due to
hemorrhage and chronic diseases could have been prevented,
as could a substantial proportion of those caused by enlargement
of the heart or other cardiac condition, pregnancy-induced
high blood pressure, infection, and choriocarcinoma (cancer
arising from fetal tissue).
The authors attribute 22 cases of preventable death to
poor quality medical care and four cases to "nonoptimal
organization of the health care system," such as failure
to plan for follow-up or transfer of the patient.
Lack of preconception care, during which patients should
have been advised about the risks associated with serious
medical conditions, was responsible for eight deaths.
Patient actions, such as failure to adhere to medical
advice or to seek care in a timely fashion, were involved
in 14 deaths.
"In-depth review of pregnancy-related deaths can help
determine strategies needed to continue making pregnancy
safer," Berg and her associates conclude.
SOURCE: Obstetrics and Gynecology, December 1, 2005.
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