Maternal death rates have remained constant in the United States for many decades. Are there any improvements in health care that could reduce these rates further?
In a study published in the July 2008 issue of the American Journal of Obstetrics & Gynecology, researchers examined all maternal deaths in nearly 1.5 million birth records from the last 6 years to look for possible keys to saving more mothers. The study demonstrated that the risk of death attributable to cesarean delivery, approximately 2/100,000 procedures, can realistically be reduced only with universal thromboembolism prophylaxis for patients delivered by cesarean.
The study identified 95 maternal deaths among 1,461,270 births (6.5/100,000 births). Leading causes of death were complications of preeclampsia, amniotic fluid embolism, obstetric hemorrhage, cardiac disease, and pulmonary thromboembolism.
The risk of death causally related to cesarean delivery is approximately 2/100,000 cesareans vs 0.2/100,000 deaths caused by vaginal birth. This statistically significant difference (P<.001) translates into approximately 20 US deaths caused by cesarean delivery annually.
Nine patients died from pulmonary thromboembolism, 7 after cesarean delivery and 2 after vaginal birth. None had received peripartum thromboembolism prophylaxis in the form of either fractionated or unfractionated heparin or pneumatic compression devices.