The MMR in the United States has decreased drastically in the last century because of advances in surgical technique, safer anesthesia, antisepsis, and overall improved living conditions.
Although the MMR has been the most common indicator for international comparisons of maternal health, it does not specify the cause of death in relation to pregnancy. ( 1) However, according to the WHO definition, maternal deaths do not include those from accidental or incidental causes. The World Health Organization (WHO) has defined maternal mortality ratio (MMR) as “the number of maternal deaths per 100,000 live births, maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy,” regardless of whether the cause was related to or aggravated by pregnancy. Maternal death during pregnancy, childbirth, or postpartum is a tragedy with catastrophic impact on families and serves as an important indicator of the quality of a health system. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond 2) addressing structural racism and the social determinants of health 3) implementing hospital-wide safety bundles with team training and simulation 4) providing patient education on early warning signs for medical complications of pregnancy and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. Significant racial/ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women.
Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining.
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