maternal mortality in pregnancy and childbirth

Last reviewed 05/2021

Maternal mortality is defined as death while pregnant or within 42 days of termination of pregnancy.

• tenth revision of the International Classification of Diseases, Injuries and Causes of Death, (ICD 10) defines a maternal death as 'the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes'
  • this means that there was both a temporal and a causal link between pregnancy and the death
    • when the woman died, she could have been pregnant at the time, that is, she died before delivery, or within the previous 6 weeks have had a pregnancy that ended in a live birth or stillbirth, a spontaneous or induced abortion or an ectopic pregnancy
    • the pregnancy could have been of any gestational duration. In addition, this definition means that the death was directly or indirectly caused by the fact that the woman was or had recently been pregnant. Either a complication of pregnancy, a condition aggravated by pregnancy or something that happened during the course of caring for the pregnant woman caused her death

Historically, maternal mortality was high. As late as 1928, 1 in 250 pregnant women died. In such circumstances it is clear that the primary responsibility of the obstetrician was to preserve the life of the woman with correspondingly less attention to the life of the foetus.

Maternal mortality may be direct or indirect:

• direct maternal death results from the complications of pregnancy, labour or puerperium, or from intervention, omission of, or incorrect, treatment
  
  
• indirect maternal death results from the interaction of pregnancy with unrelated medical conditions which may predate conception or may first appear during pregnancy, labour or the puerperium

Today, maternal mortality is so low that attention is drawn more to perinatal mortality figures. Nevertheless, each case of maternal death is a tragedy for the maternity unit and the family involved.

• maternal mortality rate, calculated from all maternal mortality Directly or Indirectly due to pregnancy identified by this Enquiry, for 2006-08 was 11.39 (95% CI 10.09-12.86) per 100 000 maternities compared with the 13.95 (95% CI 12.45-15.64) per 100 000 maternities reported for the previous triennium, 2003-05.

Reference:

• Centre for Maternal and Child Enquiries (CMACE). Saving Mothers'Lives: reviewing maternal deaths to make motherhood safer: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the Uni- ted Kingdom. BJOG 2011;118(Suppl. 1):1-203.