U.S. widely misses target for maternal mortality: data from 1991-1999.(Obstetrics)

SAN FRANCISCO -- The overall U.S. maternal mortality rate was pegged at 12 deaths per 100,000 pregnant women during the period between 1991 and 1999, according to data from the Centers for Disease Control and Prevention.

That rate is a far cry from the Healthy People 2000 objective of no more than 3 maternal deaths per 100,000 live births, Dr. Samuel C. Hughes said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

The United States also lags behind 20 other countries that have met the World Health Organization's goal of reducing maternal deaths in pregnancy to "almost irreducible numbers. We are not there, and relatively far from it," explained Dr. Hughes, director of obstetric anesthesia at San Francisco General Hospital.

Maternal mortality was more likely in women who were older or black, had the least number of years of education, or lacked prenatal care. The maternal mortality rate in U.S. black women, for example, was 30 per 100,000, compared with 810 per 100,000 white women (MMWR Surveill. Summ. 52:1-8, 2003).

Although 60% of maternal deaths in the study period involved live births, a "startling" 4% were related to abortions and 6% involved ectopic pregnancies, he said. "Both of these could be dramatically lowered," Dr. Hughes commented.

Embolism replaced hemorrhage as the leading cause of pregnancy-related maternal mortality. Other leading causes of maternal deaths included hypertensive disorders, infection, and cardiomyopathy.

Anesthesia-related deaths accounted for less than 2% of the 4,200 maternal deaths in 1991-1999. A separate analysis of data up to 1990 suggests that this decline comes from a decreased death rate in pregnant women receiving regional anesthesia, which dropped from 9 deaths per 1 ...