CPM Winter 2020 - 26

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Features

W
Maternal
Mortality
is Rising in the
United States While
it is Falling Throughout
the World
By VIRGINIA E. HALL, MD,
FACOG, FACP, FCPP

hat is maternal mortality? The
simplest definition is death of
a woman while she is pregnant
or within 42 days of delivery
of an infant or infants. That definition used by
our Center for Disease Control and Prevention
(CDC) misses the late maternal deaths that can
occur until 1 full year after delivery. Maternal
deaths also include those with ruptured ectopic
pregnancy and its associated life-threatening
internal hemorrhage, as well as infections and
excessive bleeding associated with miscarriages
and pregnancy termination. Suicide, homicide,
and motor vehicle accidents also contribute to
maternal mortality. It is well to remember that
intimate partner violence begins in pregnancy
in 25% of cases. Maternal Mortality Review
Committees formed in 40 out the 50 states
study maternal mortality for a full year after
pregnancy ends (with the exception of South
Carolina, which only studies for 42 days post
pregnancy end) have been fairly active with goals
of preventing maternal death and severe injury.
Pennsylvania established its MMRC through Act
24 in 2018 and covers maternal deaths up to 1
year after the pregnancy's end. Some deaths are
directly attributable to pregnancy itself such as
hemorrhage, pregnancy associated hypertension,
infection, and blood clots. Pre-existing heart
disease, hypertension, diabetes and obesity impact
pregnancy negatively if not appropriately cared
for. It is estimated that 60% of maternal deaths
are preventable and yet maternal mortality is
rising in the United States. This country now has
the highest maternal mortality of any developed
country in the world according to UNICEF and
WHO (World Health Organization). We lose 19
mothers for every 100,000 live born infants each
year; that number has almost doubled from 10
since 2010 whereas there has been a 37% decrease
in maternal deaths worldwide. The American
Congress of Obstetricians and Gynecologists has
designated January 23, 2020 as Maternal Health
Day and many state legislatures have designated
1/23 of each year as Maternal Health day.
As concerned professionals and citizens, we
must change these statistics. Why are American
women dying? The usual culprits of hemorrhage,
hypertension, and infection are still present but

26 Winter 2020 Central PA Medicine
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CPM Winter 2020

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