Материнська смертність та перинатальна смертність

In 2020, overall maternal mortality rate in the US was 23.8 deaths/100,000 live births (1). The maternal mortality rate is higher in the US than in European countries (eg, Germany, Netherlands, Poland, Spain, Sweden, Switzerland, United Kingdom).

Коефіцієнти материнської смертності в окремих країнах

Maternal mortality ratio refers to the number of women who die from pregnancy-related causes during pregnancy or within 42 days of the end of the pregnancy per 100,000 live births. In 2017, ratios ranged from 2 (Poland) to 1150 (South Sudan) per 100,000 live births (countries not shown). The maternal mortality ratio is higher in the US than in other Western countries. Data from the World Health Organization, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), The World Bank, and the United Nations Population Division. Trends in Estimates of Maternal Mortality Ratio (MMR; Maternal Deaths per 100,000 Live Births) 2000–2017. Geneva, World Health Organization, 2019.

Disparities by race and ethnicity in maternal mortality are significant worldwide. In the US, rates in 2020 were highest in non-Hispanic Black women (55.3/100,000), compared with 18.2/100,000 in Hispanic women and 19.1/100,000 in non-Hispanic White women (1).

In Brazil, the maternal mortality is about 5 times higher in women of African descent than in White women; in the United Kingdom, it is higher in Black women than in White women (2).

Worldwide, the percentage of maternal deaths occur as follows (3):

• Antepartum: 25%

• Intrapartum and postpartum: 25%

• Late postpartum: About 30%

• More than 42 days but less the 1 year after delivery: About 20%

Maternal death statistics include direct obstetric and indirect causes. The most common causes of maternal death worldwide are

• Hemorrhage (27.1%)

• Hypertensive disorders, including preeclampsia (14.1%)

• Sepsis (10.7%)

• Abortion, including induced abortion, miscarriage, and ectopic pregnancy ( ≥ 8%)

• Pulmonary embolism (3%)

• Obstetric complications

• Other factors (eg, preexisting disorders such as obesity, operative delivery, and infectious diseases [eg, HIV infection])

Usually, several factors contribute to maternal mortality (4). They include

• Delay in deciding to seek care

• Delay in arriving at an appropriate health care facility (often because of distance or lack of transportation)

• Delay in receiving adequate care at a health care facility

About 3 of 5 maternal deaths are preventable (5).

Perinatal mortality rate is defined as the number of deaths of infants < 7 days of age and fetal deaths at ≥ 28 weeks of gestation per 1000 live births. The US perinatal mortality rate in 2019 was 5.7 perinatal deaths per 1000 live births—a 4% decrease from 2017 (6).

Rates by race and ethnicity were

• 4.7 for non-Hispanic children of White women

• 9.9 for children of non-Hispanic Black women

• 5.1 for children of Hispanic women

The most common causes of perinatal death (7) are

• Obstetric hemorrhage (27%)

• Maternal disorders (eg, hypertensive disorders [14%], sepsis [11%], abortion [8%], embolism [3%], preexisting medical disorders [the remaining percentage])

• Infection

• Placental abnormalities

• Genetic abnormalities in the fetus

• Congenital malformations

• Preterm delivery

Other maternal characteristics that increase the risk of perinatal mortality include maternal age (much younger or older than average), smoking, and multiple gestations.