Laird Harrison

May 08, 2015

SAN FRANCISCO — There has been an increase in the rate of maternal mortality caused by hemorrhage in hospitalized women in the United States, according to a retrospective cohort study. Sepsis rates, however, appear to be dropping.

"Hemorrhage is increasing because of the increased cesarean rate," said Anita Kuriya, MD, from the McGill University Health Center and Jewish General Hospital in Montreal.

In addition, more aggressive treatment might be suppressing the incidence of sepsis, she told Medscape Medical News.

Dr Kuriya presented the study results here at the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting 2015.

She and her colleagues used data from the Nationwide Inpatient Sample to identify women who gave birth or died during pregnancy from 2003 to 2011.

Of 7,775,868 pregnancies, there were 1102 maternal deaths, for a rate of 14.2 deaths per 100,000 births. Although sepsis was the most common cause of death in 2003, that declined over the study period.

Table: Leading Causes of Maternal Mortality

Cause 2003–2011, % 2003–2005, % 2006–2008, % 2009–2011, % P Value
Sepsis 20.6 33.2 18.4 10.0 <.001
Cardiac disease 17.8 15.1 16.7 21.5 NS
Hemorrhage 16.2 8.2 18.7 22.0 <.001
Venous thromboembolism 15.2 19.1 13.3 12.9 NS

 

Other studies have found a three-fold increase in maternal mortality in the United States in the past 23 years, Dr Kuriya reported.

The fact that this analysis showed the numbers holding steady during the study period could be the result of coding errors. Some women in the sample might have been lost to follow-up, so their deaths might not have been recorded as being related to childbirth, she explained.

These results conflict with others from studies that have found venous thromboembolism to be the most common cause of maternal mortality. This could be because physicians are becoming more effective in preventing thromboembolism with anticoagulants, Dr Kuriya reported.

Meanwhile, other causes of death are rising. "The number of women conceiving with comorbidities is increasing," she said.

The high rate of mortality from cardiac disease in the study stood out for Baron Atkins, MD, an obstetrician-gynecologist practicing in Arlington, Texas.

"The incidence of underlying cardiac disease in our pregnant women is something we don't give much thought to," he told Medscape Medical News.

Other factors that might be driving the changes in maternal mortality include increases in maternal age and obesity, he said.

This study highlights the gaps in data collection for maternal mortality, said Thomas Westover, MD, from Cooper University Health Care in Camden, New Jersey.

He pointed out that the study showed a drop in amniotic fluid embolism — from 54 cases in 2003–2005 to 0 in 2006–2011. "Clearly, that's not true," he told Medscape Medical News.

"You can say it's the best snapshot we have," he said, "but it's only a snapshot."

Dr Kuriya, Dr Atkins, and Dr Westover have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting 2015: Abstract 294. Presented May 5, 2015.

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