Maternal death certificates with identifiers removed matched with live birth or fetal death certificates when available from were reviewed to identify deaths due to anesthesia, the cause of death, the procedure for delivery, and the type of anesthesia provided. Maternal mortality rates per million live births were calculated. Case fatality rates and risk ratios were computed to compare general to regional anesthesia for cesarean section deliveries.
The anesthesia-related maternal mortality rate decreased from 4. The number of deaths involving general anesthesia have remained stable, but the number of regional anesthesia-related deaths have decreased since The case-fatality risk ratio for general anesthesia was 2. Most maternal deaths due to complications of anesthesia occurred during general anesthesia for cesarean section. Regional anesthesia is not without risk, primarily because of the toxicity of local anesthetics and excessively high regional blocks.
The incidence of these deaths is decreasing, however, and deaths due to general anesthesia remain stable in number and hence account for an increased proportion of total deaths.
Heightened awareness of the toxicity of local anesthetics and related improvements in technique may have contributed to a reduction in complications of regional anesthesia. Death due to anesthesia is the sixth leading cause of pregnancy-related mortality in the United States. Deaths from this cause are particularly lamentable because many of these anesthetics are elective, they are provided to young mothers in the prime of life, and some might be prevented if more experienced personnel were provided.
Anesthesiologists in the United States have historically relied on data from the Report on Confidential Enquiries into Maternal Deaths in the United Kingdom to describe the causes and incidence of anesthesia-related complications that lead to maternal death. Although the total numbers of deaths from complications of anesthesia during pregnancy in this country have been reported, [2,6] analyses of national data on anesthetic-related deaths have not been published previously.
We studied maternal deaths reported in the United States from — to determine the cause, the relation to the type of anesthetic, the type of obstetric procedure performed, and any associated maternal conditions.
Although a detailed analysis of each case was precluded because complete information was not available from vital records, this study offers a first national look at the magnitude and causes of anesthesia-related pregnancy deaths. An understanding of the risks of obstetric anesthesia should make it possible to provide recommendations to improve the care of all parturients and to decrease the number of deaths from this cause.
In , the Centers for Disease Control and Prevention CDC established an ongoing National Pregnancy Mortality Surveillance System, which is a system to monitor maternal deaths at the national level and conduct epidemiologic studies of the deaths of pregnant women. A woman's death was classified as pregnancy related if it occurred during pregnancy or within 1 yr after delivery and resulted from 1 complications of the pregnancy itself, 2 a chain of events initiated by the pregnancy, or 3 the aggravation of an unrelated condition by the physiologic or pharmacologic effects of pregnancy.
Three obstetric anesthesiologists independently reviewed the maternal death certificates and matched live birth or fetal death certificates for each of the cases to confirm that the death resulted from a complication of anesthesia.
If all three anesthesiologists confirmed from the vital records information that the death resulted from an anesthesia-related complication, they then determined the cause of death, procedure for delivery, and type of anesthesia provided. Because vital records are often incomplete concerning the events surrounding the death, if all three anesthesiologists evaluating the records independently could not agree, the information was coded as unknown. We classified deaths by the CDC system, which distinguishes among the immediate and underlying causes of death as stated on the death certificate, associated obstetrical conditions or complications, and the outcome of pregnancy.
After an initial analysis of these cases, the 20 abortion-related deaths and the six deaths related to ectopic pregnancy were excluded so that cases associated with an obstetric delivery live births or stillbirths were evaluated. We calculated pregnancy mortality rates per million live births using national data on live births from the — natality files of the National Center for Health Statistics. To compare the risks of general versus regional anesthesia during cesarean section, we estimated case-fatality rates for two time periods: — and — We used these periods for three reasons: 1 The annual number of anesthesia-related deaths were too small to compute reliable annual rates, 2 the two time periods divided the study period into equal 6-yr blocks, and 3 changes in the clinical practice of obstetric regional anesthesia occurred after with the withdrawal of 0.
This latter change may have influenced rates of mortality from local anesthetic toxicity. Case-fatality rates were computed by the following procedure. First, we determined the national number of live births for each year during the period — Second, we applied national cesarean section rates for each year, derived from National Hospital Discharge Survey data, to the number of live births, and then calculated the number of cesarean section deliveries for each of the two periods.
For the years —, the percentages of women who received regional or general anesthesia for cesarean section were estimated from a survey of obstetricians and anesthesia personnel conducted in For the period , we obtained data on anesthesia administration from a similar survey of obstetricians and anesthesia personnel conducted in The two manpower surveys used for these estimates were conducted in a similar manner. Census region, and a stratified random sample of hospitals was selected.
Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. Finally, we calculated case-fatality rates by dividing the number of deaths associated with general or regional anesthesia during cesarean section in a given period by the estimated number of administrations of that type of obstetric anesthesia during cesarean section delivery in the same period.
We used regional anesthesia as the referent for comparison with the risk associated with general anesthesia. To compare U. Because we based the denominator for U. Characteristics of the women who died of complications of anesthesia during delivery in the study period — are shown in Table 1.
They tended to have 12 or more years of education and to have begun prenatal care in the first trimester of pregnancy Table 1. Table 1. The causes of anesthesia-related death varied by the type of anesthesia administered Table 2.
These deaths usually resulted from local anesthetic toxicity or an inadvertent high spinal or epidural block. In three or four cases, airway management problems were the cause of these deaths.
The type of anesthesia associated with maternal deaths changed during the yr study period Figure 1. The number of deaths from complications of anesthesia during delivery decreased with time.
Most deaths related to general anesthesia during this period resulted from aspiration and intubation problems, and most deaths related to regional anesthetic resulted from local anesthetic toxicity Table 2. In contrast, after there was an abrupt decrease in deaths due to regional anesthesia. Fewer deaths due to local anesthetic toxicity were reported after The number of anesthesia-related deaths in which cause of death and characteristics of the woman were unknown also decreased with time.
We calculated case-fatality rates for women who had a cesarean section delivery with general or regional anesthesia for the two periods — and — Table 3. The estimated rate of death from complications of general anesthesia during cesarean section increased from 20 deaths per million general anesthetics administered in the earlier time period to In contrast, the rate of death during cesarean section delivery using regional anesthesia decreased from 8.
From —, the risk of death from complications of general anesthesia during cesarean delivery was 2. From —, the rate of death related to regional anesthesia decreased, and concomitantly the use of regional anesthesia for cesarean section delivery increased. Therefore the risk of death from complications of general anesthesia increased to The lowest MMR was for women in the 20 to 24 age group, followed by women in the 30 to 34 age group 2. In the same period, the MMR for non-Indigenous women was 5.
The rate of maternal death increased with parity, from an MMR of 4. The rate of maternal deaths was higher in women who reported smoking during the first 20 weeks of pregnancy than in women who reported that they did not smoke during the first 20 weeks of pregnancy The rate of maternal death in areas other than Major Cities should be treated with caution due to the small numbers.
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Please use a more recent browser for the best user experience. Print this page Click to open the social media sharing options Share. Maternal deaths in Australia Web report. Last updated: 14 Dec View citation formats for this report Citation Close. MLA Maternal deaths in Australia.
Vancouver Australian Institute of Health and Welfare. Save web report. Enter the email address where you would like the PDF sent. This address will not be used for any other purpose. Please enter your Email address Valid email required. Latest edition. Findings from this report: Maternal death was more common in women of higher parity. Maternal deaths in Australia In Australia, where childbirth is safe for most women, maternal death is rare.
Figure 1: Maternal deaths in Australia, Maternal mortality over time The incidence of maternal death is expressed as the maternal mortality ratio MMR. Chart title: Maternal mortality ratio, by year, The horizontal bar chart shows that the maternal mortality ratio ranged between 5. Add to cart. Sold by worldofbooksusa Show More Show Less.
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