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Washington, DC — The overall maternal mortality rate in the US is not as low as it could be, according to a review of pregnancy-related deaths published in the December issue of Obstetrics & Gynecology. The review found that 40% of all pregnancy-related deaths in North Carolina from 1995-1999 were potentially preventable. Worldwide, complications of pregnancy are a major source of mortality among women. Although the US saw a 99% reduction in maternal death during the 20th century, 29 developed nations still have lower maternal mortality rates.

The North Carolina Pregnancy-Related Mortality Review Committee examined 108 cases in which death occurred within one year of the end of the pregnancy and was caused by the pregnancy or its treatment. The study found that 41 of these deaths may have been averted by one or more changes in the health care or counseling provided or by changes in patient actions. Results suggest that lack of preconception care, patient actions, failures in the health care system, and a substandard quality of care were the four main contributors in the preventable deaths.

In cases involving lack of preconception care, there was no evidence that women with serious medical conditions were counseled about the risks of pregnancy before becoming pregnant. Patient actions contributed to mortality when women did not follow medical advice, failed to follow up with care or recommended therapies, or failed to seek care in a timely fashion. In some instances, failures in the health care system led to inadequate planning for patient follow-up or transfer. Quality of care contributed to mortality when the care provided was below expectations for the level of facility in question.

Preventable causes included hemorrhage, pregnancy-induced hypertension, and complications of chronic disease (e.g. cardiovascular disease). Deaths from conditions such as amniotic fluid embolism were not considered preventable.

Researchers suggest more comprehensive study of maternal mortality cases and an open dialogue among clinicians to develop strategies that will continue to make pregnancy even safer for US women.

Contact: Cynthia J. Berg, MD, Centers for Disease Control and Prevention, Atlanta, GA, at

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Studies published in Obstetrics & Gynecology, the peer-reviewed scientific journal of The American College of Obstetricians and Gynecologists (ACOG), do not necessarily reflect the policies or opinions of ACOG. ACOG is the national organization representing over 49,000 members who provide health care for women.

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