Obstetric Hemorrhage-Related Maternal Mortality and Morbidity

In 2006, approximately 124,708 (2.9%) women in the United States who gave birth suffered a postpartum hemorrhage, representing a 26% increase in postpartum hemorrhages compared to 2.3% of women who gave birth in 1994. ¹ Kuklina et al. ² also reported a 92% increase in the number of obstetric-related blood transfusions in 2004–2005 compared–1998–1999.

Obstetric hemorrhage consistently remains the most common cause of maternal death in the United States. ³ Researchers in four different research studies reported that 54%–93% of obstetric hemorrhage-related maternal mortality may have been preventable had the women received more timely and adequate treatment. ^{4 –7} In a study by Tucker et al., ⁸ black women did not have a higher prevalence of obstetric hemorrhage but were two to three times more likely than white women to die from obstetric hemorrhage. Tucker et al.'s study is provocative because it suggests that black women may have less access to efficacious treatments than white women.

Much of the rise in obstetric hemorrhage-related maternal morbidity and mortality has been attributed to the overuse of inductions and cesarean surgery. ² Several state departments of health have been working to eliminate preventable obstetric hemorrhage-related deaths and injuries. ^5,9,10 These state efforts are significant and need to be continued. To date, however, none of these states have published the outcomes of these publicly funded initiatives. In addition, there is no public accountability for hospital leaders whose rates of obstetric hemorrhage-related deaths and injuries are excessive when compared with other hospitals. There is also a lack of timely and comprehensive feedback to the front-line physicians, nurses, and midwives in the United States. Consider how difficult it is for clinicians to make adjustments in the care they provide when the data they have is often 7 years old and usually not specific to them and the patients they serve, and the data that are available do not have enough information on clinical practices to make it possible for them to compare themselves with other clinicians. ¹¹ No business could be highly effective and successful with such a dearth of data.

Learning from mistakes cannot occur without review and reflection; however, 29 states currently do not have maternal mortality review committees, and there is no standard methodology or process for performing a review that makes it possible from a national perspective to share the lessons learned. ¹² When mortality reviews are performed, the reports are often published many years after the deaths occurred or not at all. ^6,11 Sharing the lessons learned from the deaths and injuries that do occur should be encouraged and routine. In Illinois, however, the maternal mortality reviewers had to push the state department of health to make it possible for them to share the opportunities for improvement they identified during the review process. ⁵

Given the current data limitations that hamper the ability for clinicians and hospital leaders to learn from their errors and make adjustments in their clinical practice, the residents of the United States should not be surprised that there are many women who have died and many women who will yet die whose deaths may have been prevented.