Indirect maternal mortality

Indirect maternal deaths are defined as those resulting from a previously existing disease or a disease that developed during pregnancy which did not have a direct obstetric cause but which was aggravated by the physiological effects of pregnancy.

• maternal mortality rate, calculated from all maternal mortality Directly or Indirectly due to pregnancy identified by this Enquiry, for 2006-08 was 11.39 (95% CI 10.09-12.86) per 100 000 maternities compared with the 13.95 (95% CI 12.45-15.64) per 100 000 maternities reported for the previous triennium, 2003-05
  
  
• mortality rate for mothers' deaths from Indirect causes, that is from pre-existing or new medical or mental health conditions aggravated by pregnancy such as heart disease or suicide, remains largely unchanged
  • rate for 2006-08, at 6.72 (95% CI 5.74-7.87) per 100 000 maternities, has not significantly altered (P = 0.22) from the 7.71 (95% CI 6.61-8.99) per 100 000 maternities identified in the last Report 2003-05
  • since 1994, the numbers and rates of maternal deaths from Indirect causes have been consistently higher than those for Direct deaths
    
    
• although there has been a significant increase (P < 0.001) in mortality rates from Indirect causes since 1985, this can probably be explained by far better case ascertainment and inclusion of cases that might have been considered as Coincidental in the past, such as suicides and hormone-dependent malignancies
  • cardiac disease was again the leading cause of deaths from Indirect causes as well as being the leading cause of death overall
  • mortality rates for deaths from Other Indirect causes due to pre-existing medical conditions and those from neurological conditions are also higher than for the leading cause of Direct death, sepsis
  • deaths from suicide, the leading cause of maternal deaths in 2000-02, have dropped a little more and now equal those from amniotic fluid embolism.

Reference:

• Centre for Maternal and Child Enquiries (CMACE). Saving Mothers'Lives: reviewing maternal deaths to make motherhood safer: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the Uni- ted Kingdom. BJOG 2011;118(Suppl. 1):1-203.