The overall maternal death rate in the US is not as low as it could be, according to a review of pregnancy-related deaths in North Carolina, which suggests that about four out of every 10 pregnancy-related deaths are potentially preventable.

“Despite the decline in pregnancy-related mortality rates, almost one half of these deaths could potentially be prevented, mainly through improved quality of medical care,” investigators note in the December issue of Obstetrics and Gynecology.

The fact that several other developed countries have maternal mortality ratios lower than that of the US, and that some racial and ethnic groups have higher risks of pregnancy-related death, led lead investigator Dr. Cynthia J. Berg and her colleagues to theorize that maternal mortality rates could be lower than they are.

The North Carolina State Center for Health Statistics combed through four computerized databases to identify 108 pregnancy-related deaths that occurred between 1995 and 1999. Berg and her team evaluated these cases and concluded, based on the cause of death, that 41 cases could have been prevented.

Their analysis showed that 90 percent of deaths due to hemorrhage and chronic diseases could have been prevented, as could a substantial proportion of those caused by enlargement of the heart or other cardiac condition, pregnancy-induced high blood pressure, infection, and choriocarcinoma (cancer arising from fetal tissue).

The authors attribute 22 cases of preventable death to poor quality medical care and four cases to “nonoptimal organization of the health care system,” such as failure to plan for follow-up or transfer of the patient.

Lack of preconception care, during which patients should have been advised about the risks associated with serious medical conditions, was responsible for eight deaths. Patient actions, such as failure to adhere to medical advice or to seek care in a timely fashion, were involved in 14 deaths.

“In-depth review of pregnancy-related deaths can help determine strategies needed to continue making pregnancy safer,” Berg and her associates conclude.

SOURCE: Obstetrics and Gynecology, December 1, 2005.