Enhanced surveillance of maternal mortality in North Carolina.

In 1916, there were 774 pregnancy-related deaths per 100,000 live births in North Carolina; by 1999 this ratio had declined to 12.3 deaths/100,000 live births (See Figure 1). Over the same time span, the annual number of pregnancy-related deaths decreased from 593 to 14. The decline in pregnancy-related deaths (based on death certificate records) is attributed to improved obstetrical care and particularly the use of effective antibiotics, which dramatically reduced deaths due to infection. 1 The legalization of induced abortion in the early 1970s significantly furthered the decline in pregnancy-related deaths in North Carolina 1,2 by removing the risk of illegal abortion. 2 Since there has been a very large reduction in pregnancy-related deaths over this century, one might ask why public health officials are still interested in maternal mortality. First, because maternal mortality is an indicator of the overall effectiveness of the obstetrical health care system and the health care system in general. Second, because persisting, still large discrepancies in maternal mortality among various demographic groups indicate the potential for further prevention. Third, because there has been little improvement in maternal mortality in North Carolina and the United States since the early 1980s. And fourth, because we have not nearly reached the Healthy People 2000 goal of 3.3 maternal deaths/ 100,000 live births. A persisting problem is that pregnancy-related deaths, though relatively rare, are seriously underreported in death certificate data. The State Center for Health Statistics and Wake Forest University School of Medicine are cooperating in a program to enhance surveillance of pregnancy-related deaths in North Carolina. A more complete ascertainment of pregnancy-related deaths and better characterization of the causes should allow us to prevent many of these deaths. The State Center for Health Statistics links several data bases in order to identify pregnancy-related deaths. 3 The Wake Forest University School of Medicine reviews each identified death in detail to confirm its relation to pregnancy and assign an accurate cause of death. In this report we describe the collaborative enterprise, which began in its current form in 1988, and present some current statistics on maternal mortality in North Carolina. Methods Identification of maternal deaths is done on an annual basis. We start with deaths identified through death certificates as being related to pregnancy (ICD-9 codes 630-676, ICD-10 codes O00-O99). A nosologist flags death certificates that have some written mention of pregnancy but do not list a pregnancy-related cause-of-death code. …