Maternal mortality: new strategies for measurement and prevention

PURPOSE OF REVIEW: Maternal mortality has recently been featured in both lay and professional literature often with a high degree of passion. This review will provide the obstetrician with a background of the current issues with maternal mortality. RECENT FINDINGS: Current international data suggest significant improvement in maternal mortality in most countries with the exception of the United States. US data are confounded by changes in data definitions and data collection techniques but the best estimate is that we have seen an actual increase in US maternal mortality over the last 8 years. Importantly, maternal mortality is not a single diagnosis, and each underlying cause has its own pathophysiology, drivers, contributing factors and possibilities for prevention. Current leading causes include cardiac disease and cardiomyopathy, venous thromboembolism, obstetric hemorrhage and pre-eclampsia. The majority of deaths from these causes have reasonable degrees of preventability. The African-American maternal mortality disparity (three to four times white) is among the worst of any health outcome measure and needs further attention although current evidence indicates a combination of social, behavioral and medical care factors. SUMMARY: Maternal mortality has re-emerged as an important measure for assessing maternity care and the United States has significant opportunities for improvement.