Report

Maternal deaths in Australia 1997-1999

Publisher
Maternal and infant welfare Deaths Australia
Description

This is the twelfth in a series of triennial reports on maternal deaths dating back to 1964. Under-ascertainment of maternal mortality is of national concern. In an effort to improve ascertainment of maternal deaths, this report has used two data sources: states and territories confidential maternal death enquiries and Australian Bureau of Statistics death data.

Preface
This is the twelfth in a series of triennial reports on maternal deaths dating back to 1964. Under-ascertainment of maternal mortality is of national concern. In an effort to improve ascertainment of maternal deaths, this report has used two data sources: states and territories confidential maternal death enquiries and Australian Bureau of Statistics death data.

This report includes data on 90 deaths reported to the National Advisory Committee on Maternal Mortality (34 direct, 28 indirect and 28 incidental) which satisfied the definition of maternal mortality, for the triennium 1997–99. The 34 direct deaths represent a decrease from the 46 direct deaths recorded in the previous triennium and a return to the trend of declining direct maternal deaths seen over the previous 15 years. The leading principal causes of direct maternal deaths were obstetric haemorrhage (8), amniotic fluid embolism (7) and deaths due to thromboembolism (6).

The number of indirect deaths increased compared with the previous triennium (28 in 1997–99), while the number of incidental deaths decreased (28 in 1997–99). This is in part due to a change in the classification of deaths due to psychiatric causes from incidental to indirect, consistent with international reporting practices. The incidence of deaths due to psychiatric causes is increasing. This trend coupled with the probability that psychiatric deaths are underestimated is of concern.

The maternal mortality ratio (MMR) is used for international comparisons. It is calculated on the number of direct and indirect deaths in the reporting period. Because of historical difficulties in classification of some maternal deaths between indirect and incidental, Australia has in the past calculated MMR including incidental deaths. This practice is not consistent with international reporting protocols. Using the WHO definition, the MMR for this triennium is 8.2 deaths per 100,000 confinements, compared with the recalculated ratio of 9.1 deaths per 100,000 confinements in the 1994–96 triennium. The MMR of 8.2, while not as low as that observed in the 1991–93 triennium, is a return to the steady decline of the MMR observed in the past 24 years.

The maternal mortality ratios for direct and indirect deaths were 4.5 and 3.7 per 100,000 confinements respectively. These figures compare with those of 5.0 and 6.4 per 100,000 confinements for direct and indirect deaths respectively, published in the Report on Confidential Enquiries into Maternal Deaths in the United Kingdom for the triennium 1997–99 (NICE 2001). In Australia in the 1997–99 triennium, the incidental maternal mortality ratio was 3.7 per 100,000 confinements, a ratio that has remained steady over the past 24 years.

It is important to note that the absolute risk of maternal death during pregnancy and the puerperium remains very small, being 1 in 8,423 confinements in the 1997–99 triennium. Improved general health status and reproductive patterns, together with access to appropriate general and specialised health care, has greatly reduced the incidence of maternal mortality in the last century.

The risk of death was highest for women aged 40-44 years who had an MMR of 23.2 deaths per 100,000 confinements and lowest for women aged 20-24 years who had an MMR of 4.0
deaths.

There has been a decrease in the number of deaths in which avoidable factors were considered to be possibly or certainly present. Avoidable factors were considered to be possibly or certainly present in 34% of cases compared with 48% of cases in 1994–96. The presence of avoidable factors is not uniformly considered and recorded by State Committees but these data give an indication of the proportion of maternal deaths with avoidable factors.

Publication Details
Publication Year:
2004