Underreporting of Maternal Deaths on Death Certificates and the Magnitude of the Problem of Maternal Mortality

Vital Statistics Administration, Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201, USA.
American Journal of Public Health (Impact Factor: 4.23). 04/2005; 95(3):478-82. DOI: 10.2105/AJPH.2004.040063
Source: PubMed

ABSTRACT I studied the extent to which maternal deaths are underreported on death certificates.
We collected data on maternal deaths from death certificates, linkage of death certificates with birth and fetal death records, and review of medical examiner records.
Thirty-eight percent of maternal deaths were unreported on death certificates. Half or more deaths were unreported for women who were undelivered at the time of death, experienced a fetal death or therapeutic abortion, died more than a week after delivery, or died as a result of a cardiovascular disorder.
The number of maternal deaths is substantially underestimated when death certificates alone are used to identify deaths, and it is unlikely that the Healthy People 2010 objective of reducing the maternal mortality rate to no more than 3.3 deaths per 100000 live births by 2010 can be achieved. Increasing numbers of births to older women and multiple-gestation pregnancies are likely to complicate efforts to reduce maternal mortality.

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    • "Researchers in Ghana [2] attributed just 7% (2/27) of unreported cases of maternal death to certification errors, similar to the 8% (4/50) identified in the present study, whereas Brazilian investigators concluded that doctors were responsible for 46% of their errors [24]. The duration of illness was not recorded on 77% of the MCCDs, limiting the ability to distinguish between maternal and late maternal deaths. "
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    ABSTRACT: Objective To identify why vital registration under-reports maternal deaths in Jamaica. Methods A cross-sectional study was undertaken to identify all maternal deaths (during pregnancy or ≤ 42 days after pregnancy ended) occurring in 2008. Data sources included vital registration, hospital records, forensic pathology records, and an independent maternal mortality surveillance system. Potential cases were cross-referenced to registered live births and stillbirths, and hospital records to confirm pregnancy status, when the pregnancy ended, and registration. Medical certificates were inspected for certification, transcription, and coding errors. Maternal mortality ratios (MMRs) for registered and/or unregistered deaths were calculated. Results Of 50 maternal deaths identified, 10 (20%) were unregistered. Eight unregistered deaths were coroners’ cases. Among 40 registered deaths, pregnancy was undocumented in 4 (10%). Among the other 36, 24 (67%) had been misclassified (59% direct and 89% indirect deaths). Therefore, only 12 (30%) registered maternal deaths had been coded as maternal deaths, yielding an MMR of 28.3 per 100 000 live births (95% confidence interval [CI] 12.3–48.3), which was 76% lower than the actual MMR of 117.8 (95% CI 85.2–150.4). Conclusion Under-reporting of maternal deaths in Jamaica in 2008 was attributable to delayed registration of coroners’ cases and misclassification. Timely registration of coroners’ cases and training of nosologists to recognize and code maternal deaths is needed.
    International Journal of Gynecology & Obstetrics 09/2014; 128(1). DOI:10.1016/j.ijgo.2014.07.023 · 1.56 Impact Factor
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    • "ntimate partner violence (IPV) has become increasingly recognized as a persistent social and public health problem, resulting in negative mental and physical health consequences for women (Dienemann et al., 2000; Petersen, Gazmararian & Clark, 2001; Plichta, 2004; Seng, 2002). IPV occurring around the time of pregnancy is a leading cause of maternal death in the United States (Horon, 2005; Krulewich, 2001). It also has been associated with low birth weight, a major source of infant mortality and long-term adverse health outcomes for children (Cokkindes, Coker, Sanderson, Addy, & Bethea, 1999). "
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    ABSTRACT: Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.
    Journal of Interpersonal Violence 11/2007; 22(10):1305-14. DOI:10.1177/0886260507304551 · 1.64 Impact Factor
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