Postpregnancy Genital Tract and Wound Infections

Nell Tharpe, CNM, CRNFA, MS


J Midwifery Womens Health. 2008;53(3):236-246. 

In This Article

Incidence of Maternal Mortality Secondary to Infection

Approximately 7.5 women per 100,000 live births die each year in the United States.[10] This figure excludes the deaths of women who undergo spontaneous and induced abortion, or whose pregnancy results in stillbirth. Persistent racial disparities in the United States exist and pregnancy-related mortality is 3 to 4 times higher for black women than white women.[4] Healthy People 2010 identified as an objective reducing maternal deaths to 3.3 per 100,000 live births from the current rate of 7 to 13 per 100,000 live births.[4,11]

Maternal deaths from all causes remain under-reported because no uniform national criteria exist for identifying and reporting maternal morbidity and mortality. Chang et al.[4] evaluated the data on all pregnancy-related maternal deaths in the United States from 1991 to 1999 that was collected by the Centers for Disease Control and Prevention (CDC) Pregnancy Mortality Surveillance System. The leading causes of death differed by pregnancy outcome. Among women who had a stillbirth, 19% of the maternal deaths were attributed to infection, whereas 34% of the deaths following spontaneous or induced abortion were attributed to infection.[4] Perhaps more importantly, it appears that maternal mortality is seriously under-reported on death certificates. Horon[6] linked death certificates to birth certificates to determine how many deaths of reproductive-age women in Maryland between 1993 and 2000 were secondary to a complication during any stage of pregnancy and up to 42 days postdelivery. She found that only 80 of 129 deaths were correctly identified as maternal mortality on the death certificate. In evaluating the role of infection, 5 of the 8 deaths that occurred secondary to infection were identified correctly on the death certificate, causing the author to conclude that 37.5% of the pregnancy-associated deaths secondary to infection were not reported as such.[6] The lack of documentation and consistent reporting standards makes it difficult to assess the overall effect of obstetric infection on maternal well being.[12]