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Maternal Mortality and Perinatal Mortality

By

Raul Artal-Mittelmark

, MD, Saint Louis University School of Medicine

Medically Reviewed Sep 2022
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In 2020, overall maternal mortality rate in the US was 23.8 deaths/100,000 live births (1 Maternal and perinatal mortality references In 2020, overall maternal mortality rate in the US was 23.8 deaths/100,000 live births ( 1). The maternal mortality rate is higher in the US than in European countries (eg, Germany, Netherlands... read more ). The maternal mortality rate is higher in the US than in European countries (eg, Germany, Netherlands, Poland, Spain, Sweden, Switzerland, United Kingdom).

Maternal mortality ratios in selected countries

Maternal mortality ratio refers to the number of women who die from pregnancy-related causes during pregnancy or within 42 days of the end of the pregnancy per 100,000 live births. In 2017, ratios ranged from 2 (Poland) to 1150 (South Sudan) per 100,000 live births (countries not shown). The maternal mortality ratio is higher in the US than in other Western countries.

Maternal mortality ratios in selected countries

Data from the World Health Organization, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), The World Bank, and the United Nations Population Division. Trends in Estimates of Maternal Mortality Ratio (MMR; Maternal Deaths per 100,000 Live Births) 2000–2017. Geneva, World Health Organization, 2019.

Disparities by race and ethnicity in maternal mortality are significant worldwide. In the US, rates in 2020 were highest in non-Hispanic Black women (55.3/100,000), compared with 18.2/100,000 in Hispanic women and 19.1/100,000 in non-Hispanic White women (1 Maternal and perinatal mortality references In 2020, overall maternal mortality rate in the US was 23.8 deaths/100,000 live births ( 1). The maternal mortality rate is higher in the US than in European countries (eg, Germany, Netherlands... read more ).

In Brazil, the maternal mortality is about 5 times higher in women of African descent than in White women; in the United Kingdom, it is higher in Black women than in White women (2 Maternal and perinatal mortality references In 2020, overall maternal mortality rate in the US was 23.8 deaths/100,000 live births ( 1). The maternal mortality rate is higher in the US than in European countries (eg, Germany, Netherlands... read more ).

Worldwide, the percentage of maternal deaths occur as follows (3):

  • Antepartum: 25%

  • Intrapartum and postpartum: 25%

  • Late postpartum: About 30%

  • More than 42 days but less the 1 year after delivery: About 20%

Maternal death statistics include direct obstetric and indirect causes. The most common causes of maternal death worldwide are

  • Delay in deciding to seek care

  • Delay in arriving at an appropriate health care facility (often because of distance or lack of transportation)

  • Delay in receiving adequate care at a health care facility

Perinatal mortality rate is defined as the number of deaths of infants < 7 days of age and fetal deaths at ≥ 28 weeks of gestation per 1000 live births. The US perinatal mortality rate in 2019 was 5.7 perinatal deaths per 1000 live births—a 4% decrease from 2017 (6 Maternal and perinatal mortality references In 2020, overall maternal mortality rate in the US was 23.8 deaths/100,000 live births ( 1). The maternal mortality rate is higher in the US than in European countries (eg, Germany, Netherlands... read more ).

Rates by race and ethnicity were

  • 4.7 for non-Hispanic children of White women

  • 9.9 for children of non-Hispanic Black women

  • 5.1 for children of Hispanic women

Other maternal characteristics that increase the risk of perinatal mortality include maternal age (much younger or older than average), smoking, and multiple gestations.

Maternal and perinatal mortality references

  • 1. Hoyert DL: Maternal mortality rates in the United States, 2020. Centers for Disease Control and Prevention: National Center for Health Statistics Health, E-Stats, 2022. doi: https://dx.doi.org/10.15620/cdc:113967external icon

  • 2. Small M, Allen T, Brown HL: Global disparities in maternal morbidity and mortality. Semin Perinatol 41 (5): 318–322, 2017. doi: 10.1053/j.semperi.2017.04.009

  • 3. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS: Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 13;384 (9947):980–1004, 2014. doi: 10.1016/S0140-6736(14)60696-6

  • 4. Barnes-Josiah D, Myntti C, Augustin A: The “three delays” as a framework for examining maternal mortality in Haiti. Soc Sci Med 46 (8):981–993, 1998. doi: 10.1016/s0277-9536(97)10018-1

  • 5. Petersen EE, Nicole L. Davis NL, Goodman D, et al: Vital Signs: Pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. MMWR Morb Mortal Wkly Rep 68 (18): 423–429, 2019. doi: 10.15585/mmwr.mm6818e1

  • 6. Valenzuela CP, Gregory ECW, Martin, JA: Decline in perinatal mortality in the United States, 2017–2019. Centers for Disease Control and Prevention: National Center for Health Statistics Health Data Brief No. 429, 2022.

  • 7. Say L, Chou D, Gemmill A, et al: Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health 2 (6):e323–33, 2014. doi: 10.1016/S2214-109X(14)70227-X

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