From the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; and Empowered Global Solutions, Englewood, Colorado.
Obstet Gynecol. 2010 Dec;116(6):1302-1309. doi: 10.1097/AOG.0b013e3181fdfb11.
To estimate the risk of women dying from pregnancy complications in the United States and to examine the risk factors for and changes in the medical causes of these deaths.
De-identified copies of death certificates for women who died during or within 1 year of pregnancy and matching birth or fetal death certificates for 1998 through 2005 were received by the Pregnancy Mortality Surveillance System from the 50 states, New York City, and Washington, DC. Causes of death and factors associated with them were identified, and pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were calculated.
The aggregate pregnancy-related mortality ratio for the 8-year period was 14.5 per 100,000 live births, which is higher than any period in the previous 20 years of the Pregnancy Mortality Surveillance System. African-American women continued to have a three- to four-fold higher risk of pregnancy-related death. The proportion of deaths attributable to hemorrhage and hypertensive disorders declined from previous years, whereas the proportion from medical conditions, particularly cardiovascular, increased. Seven causes of death--hemorrhage, thrombotic pulmonary embolism, infection, hypertensive disorders of pregnancy, cardiomyopathy, cardiovascular conditions, and noncardiovascular medical conditions--each contributed 10% to 13% of deaths.
The reasons for the reported increase in pregnancy-related mortality are unclear; possible factors include an increase in the risk of women dying, changed coding with the International Classification of Diseases, 10th Revision, and the addition by states of pregnancy checkboxes to the death certificate. State-based maternal death reviews and maternal quality collaboratives have the potential to identify deaths, review the factors associated with them, and take action on the findings.
估计美国妇女死于妊娠并发症的风险，并研究这些死亡的医学原因的危险因素和变化。
妊娠死亡率监测系统从 1998 年至 2005 年从 50 个州、纽约市和华盛顿特区收到了与妊娠期间或妊娠后 1 年内死亡的妇女的身份不明的死亡证明副本以及匹配的出生或胎儿死亡证明。确定了死因和与之相关的因素，并计算了与妊娠相关的死亡率（每 10 万活产的妊娠相关死亡数）。
8 年期间的总妊娠相关死亡率为每 10 万活产 14.5 例，高于妊娠死亡率监测系统前 20 年的任何时期。非裔美国妇女继续面临妊娠相关死亡的三到四倍的高风险。出血和高血压疾病导致的死亡比例从前几年下降，而医疗状况，特别是心血管疾病导致的死亡比例增加。七种死因——出血、血栓性肺栓塞、感染、妊娠高血压疾病、心肌病、心血管疾病和非心血管疾病——各自占死亡人数的 10%至 13%。
报告的妊娠相关死亡率增加的原因尚不清楚；可能的因素包括妇女死亡风险增加、国际疾病分类第 10 版编码的变化以及各州在死亡证明上增加妊娠复选框。基于州的产妇死亡审查和产妇质量合作组织有可能识别死亡、审查与之相关的因素，并对调查结果采取行动。
