Inpatient Maternal Mortality in the United States, 2002-2014.
Mulubrhan F Mogos, Kylea L Liese, Patrick D Thornton and 3 others
PMID 31609900WHAT IT FOUND
Postpartum hospitalizations had the highest inpatient maternal mortality rate, 226 per 100,000, and African American women had higher rates than white and Hispanic women.
Intrapartum deaths declined 3.6% annually.
Key findings
01Postpartum hospitalizations had the highest inpatient maternal mortality rate, 226 per 100,000, and accounted for 27.2% of all maternal deaths despite only 2% of pregnancy-related hospitalizations.
02African American women had rates of 47, 17, and 379 per 100,000 during antepartum, intrapartum, and postpartum hospitalizations, respectively, compared with 30, 5, and 160 for white women and 28, 6, and 181 for Hispanic women.
03Inpatient maternal mortality during intrapartum hospitalization decreased 3.6% annually from 2002 to 2014, while antepartum and postpartum rates remained steady.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study counted only inpatient maternal deaths, so deaths in emergency departments, homes, or outpatient settings were not included. It used administrative hospital discharge data, so diagnoses and behaviors depended on ICD-9-CM coding and could be misclassified. The data did not include gestational age or treatments received, so the study could not assess whether any treatment helped or harmed. The data did not provide the main cause of death. Cesarean section indications were not recorded, so the study could not explain why cesarean delivery was more common among women who died. Race and ethnicity were missing for one fourth of the study population and not reported by all states, limiting adjustment. The study could not test which factors explained the racial disparity in maternal mortality.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not read the higher cesarean section rate among women who died as proof that cesarean delivery caused maternal death. The study did not record why cesareans were performed or other treatments, so it cannot separate the contribution of any single component.