Pregnancy-related death, maternal death and maternal mortality

KEY POINTS

  • Pregnancy-related death is when a woman dies during or after pregnancy because of health problems related to pregnancy.

  • In the United States, the rate of pregnancy-related death is more than 3 times higher in black women than in women of other races.

  • The leading cause of pregnancy-related death in this country is cardiovascular disease, which affects the heart and blood vessels.

  • Many of these deaths can be prevented. Getting regular health care before, during and after pregnancy can help prevent them.

  • Tell your provider if you have any signs or symptoms of conditions that can cause pregnancy-related death, like heavy bleeding or headaches.

What are pregnancy-related death, maternal death and maternal mortality?

You may have heard these terms in the news lately. They mean similar things, but they’re not exactly the same. Here’s what each one means:

  • Pregnancy-related death is when a woman dies during pregnancy or within 1 year after the end of her pregnancy from health problems related to pregnancy. 
  • Maternal death is when a woman dies during pregnancy or up to 42 days after the end of pregnancy from health problems related to pregnancy. Maternal death and maternal mortality mean the same thing.

Pregnancy-related death and maternal death may be caused by:

  • A health condition (like heart disease) that you had before pregnancy that gets worse because of pregnancy
  • A pregnancy complication, like preeclampsia (a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth) 
  • Treatment you get during pregnancy

A death isn’t pregnancy-related or a maternal death if it happens as an accident, like from a car crash or a fall. 

So pregnancy-related death covers a longer period of time than maternal death. And researchers use different methods to identify a death as pregnancy-related or maternal. The differences between pregnancy-related death and maternal death are important to health care providers and other people who keep track of patterns and trends to help us understand more about why women die from conditions related to pregnancy. Because pregnancy-related death covers a longer period of time after pregnancy, it helps us focus on learning about and preventing these deaths for more women. So this article focuses on pregnancy-related death. 

Who is at risk for pregnancy-related death?

In the United States, pregnancy-related death is not common. There are nearly 4 million births in this country each year and about 700 pregnancy-related deaths. 

The rate of pregnancy-related death in this country has increased over the last 25 years and continues to rise. This increase may be because more pregnant women have health conditions like high blood pressure and diabetes that may increase the risk of complications during pregnancy. High blood pressure is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Diabetes is a medical condition in which your body has too much sugar (called glucose) in your blood. This can damage organs in your body, including blood vessels, nerves, eyes and kidneys. 

In the United States, women age 35 to 39 are about twice as likely to die from pregnancy-related causes than women age 20 to 24. For women 40 and older, the risk is even higher. 

To more fully understand pregnancy-related death in the United States, we look at racial and ethnic disparities (differences). For example, black women in this country are 3 to 4 times as likely to die from pregnancy-related causes than white women. Part of the reason for this disparity is social determinants of health. These are conditions in which you’re born, grow, work, live and age that affect your health throughout your life. For example:

  • Things in your environment, like clean water and exposure to harmful chemicals
  • What’s in your community, like housing, parks, schools and public transportation. It also includes influences on your community, like the police, laws, poverty and racism.
  • Relationships with your partner, family and friends 
  • Your health and health care
  • Your education and income

March of Dimes is looking at how social determinants and disparities affect pregnancy-related death to bring about change that helps improve the health of all women and babies.   

What can you do to reduce your risk of pregnancy-related death?

Getting regular health care before, during and after pregnancy can help you and your provider identify conditions that can cause serious health problems. Learning the signs and symptoms of conditions that cause death may help you spot them early on so you can get treatment right away. Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. 

Trust your instincts! If you’re worried about your health or your pregnancy or you have signs or symptoms of conditions that can cause problems during pregnancy, call your provider or go to the hospital. 

If you’re planning pregnancy

  • Get a preconception checkup. This is a checkup you get before pregnancy to help make sure you’re healthy when you get pregnant. Pregnancy-related death can be caused by health conditions you have before pregnancy. Finding out about them and getting treatment before you get pregnant can help prevent death. 
  • Tell your provider about any medicines you take. You may need to change to a medicine that’s safer for you and your baby during pregnancy. Make sure any health care provider who prescribes you medicine knows you’re trying to get pregnant.
  • Protect yourself from infections. For example, talk to your provider about vaccinations (like the flu shot) that can help protect you from certain diseases. Wash your hands with soap and water after using the bathroom or blowing your nose. Stay away from people who have infections. Don’t eat raw meat, fish or eggs. Use a condom to protect yourself from sexually transmitted infections (also called STIs). And don’t touch cat poop.
  • Get to a healthy weight. Eat healthy foods and do something active every day. 
  • Don’t smoke, or use harmful drugs. Tell your provider if you need help to quit.   

During pregnancy

  • Go for your first prenatal care visit as soon as you think you’re pregnant.
  • Go to all your prenatal care checkups, even if you’re feeling fine. This can help your health care provider spot and treat any health problems that may affect your pregnancy. 
  • Tell your provider about any medicines you take. Make sure any provider who prescribes you medicine knows that you’re pregnant. 
  • If you’re at risk for preeclampsia, talk to your provider about taking low-dose aspirin to help reduce your risk. Preeclampsia is a serious condition that condition that can cause pregnancy-related death. 
  • Protect yourself from infections. For example, talk to your provider about vaccinations (like the flu shot) that can help protect you from certain diseases. Wash your hands with soap and water after using the bathroom or blowing your nose. Stay away from people who have infections. Don’t eat raw meat, fish or eggs. Use a condom to protect yourself from STIs. And don’t touch cat poop.
  • Eat healthy foods and do something active every day.
  • Don’t smoke, drink alcohol or use harmful drugs. Tell your provider if you need help to quit. 

After you give birth

  • Tell your provider right away if you have you have any signs or symptoms of conditions that can cause pregnancy-related death. These can include chest pain, trouble breathing, dizziness and swelling in the legs, hands or face.
  • If you’re worried about anything or something doesn’t seem right, call your provider. 
  • If you’re having a medical emergency, call 911. 

What causes pregnancy-related death? 

We know most of the causes of pregnancy-related death. The good news is some scientists think that more than 60 percent (3 in 5) of pregnancy-related deaths can be prevented. Getting early treatment for conditions that can cause complications during and after pregnancy may help prevent death. If you have signs or symptoms of any of these health conditions, tell your health care provider right away:

Preeclampsia and eclampsia. Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). It’s when a woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Eclampsia is a rare and life-threatening condition. It’s when a woman with preeclampsia has seizures or goes into a coma. Tell your provider right away if you have signs or symptoms of preeclampsia, like:

  • Changes in your vision
  • Headache that doesn’t go away
  • Nausea, vomiting or dizziness
  • Pain in your upper right belly area or in your shoulder
  • Sudden weight gain (2 to 5 pounds in a week)
  • Swelling in the legs, hands or face
  • Trouble breathing 

Heart and blood vessel conditions

Cardiomyopathy. This is a condition that affects the heart muscle. It can make your heart larger, thicker or more rigid (stiffer) than normal, so it’s harder for your heart to pump blood. Signs and symptoms of cardiomyopathy include:

  • Swelling in your legs 
  • Fatigue (being really tired)
  • Chest pressure or having a pounding, fast or fluttering heartbeat
  •  Fainting or feeling out of breath, dizzy or lightheaded

Cardiovascular disease (also called heart disease). Heart disease includes conditions that affect the heart and blood vessels. They often affect the heart muscle or involve narrowed or blocked blood vessels that can lead to a heart attack or stroke. Common signs and symptoms of heart disease include:

  • Chest pain, discomfort or tightness
  • Dizziness or fainting
  • Extreme tiredness 
  • Nausea (feeling sick to your stomach)
  • Really fast or really slow heartbeat
  • Shortness of breath
  • Swelling in your legs, ankles or feet

Thrombotic pulmonary embolism. This is the sudden blockage of an artery in the lung. It usually happens when a blood clot in the leg travels to the lungs and blocks the flow of blood to the lungs. When a blood clot forms in a deep vein in your leg or somewhere else in your body, it’s called deep vein thrombosis (also called DVT). You’re at increased risk for thrombotic pulmonary embolism during pregnancy. Tell your provider if you have signs or symptoms of thrombotic pulmonary embolism, including: 

  • Shortness of breath, chest pain and cough
  • Having a fever
  • Feeling dizzy or lightheaded
  • Leg pain or swelling
  • Having a fast heart rate
  • Sweating or having clammy skin or skin that has a bluish color

Stroke. A stroke is when blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open. Your risk of stroke increases during pregnancy. Signs and symptoms of a stroke come on suddenly and can include: 

  • Numbness or weakness in your face, arms or legs
  • Feeling confused
  • Having trouble talking and understanding what other people are saying
  • Having trouble seeing or walking
  • Feeling dizzy
  • Having a severe headache

Hemorrhage (also called heavy bleeding)

Causes of hemorrhage that can lead to pregnancy-related death include:

  • Problems with the placenta, including placental abruption, placenta previa and placenta accreta, increta and percreta. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is when the placenta separates from the uterus before birth. Placenta previa is when the placenta lies low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta accreta, increta, and percreta happen when the placenta grows too deeply into the wall or muscles of the uterus, or grows through the uterus. If you have vaginal bleeding during pregnancy, tell your health care provider right away. If the bleeding is severe, go to the hospital. 
  • Uterine rupture. This is when the uterus tears during labor. Signs and symptoms of uterine rupture include pain, bleeding, long labor and problems with the baby (called fetal distress), like having a slow heart rate during labor.  
  • Ruptured ectopic pregnancy. This is when an ectopic pregnancy breaks open. An ectopic pregnancy happens when a fertilized egg implants itself outside the uterus and begins to grow. An ectopic pregnancy always ends in pregnancy loss. It can cause serious problems for a woman. Most of the time, ectopic pregnancies are removed by surgery. Signs and symptoms of ectopic pregnancy include vaginal bleeding; pain in your shoulder, lower back or pelvic area (the part of your body between your stomach and your legs); and feeling dizzy or faint. If you have any of these signs and symptoms, call your provider right away. 
  • Retained products of conception. This is tissue from the placenta or from your baby that stays in your uterus after a pregnancy ends. Signs and symptoms include fever, bleeding, pelvic pain and tenderness of the uterus. 
  • Uterine atony. This is when the uterus doesn’t contract (tighten) as strongly as it should after the placenta is delivered after your baby is born. Normally, uterine contractions help stop the bleeding after the placenta separates from the uterus. But when these contractions aren’t strong enough, hemorrhage can happen. Signs and symptoms of uterine atony include heavy bleeding and not having contractions after giving birth.
  • Tears in the cervix, vagina or a blood vessel in the uterus

Infection

When you’re pregnant, your immune system isn’t as quick to respond to infections (illnesses caused by bad germs) as it was before pregnancy. So you’re more likely to get infections during pregnancy that can cause problems for you and your baby. Infections that can cause pregnancy-related death include:

  • Chorioamnionitis. This is an infection of the amniotic fluid and tissue that surround a baby in the womb. Signs and symptoms of this infection include fever, fast heart rate in you or your baby, a uterus that’s tender to the touch and discharge from the vagina that smells bad. 
  • Flu (also called influenza). The flu is a serious disease that can cause fever, chills, cough, sore throat and body aches. It’s safe to get the flu shot during pregnancy. It protects you and your baby from serious health problems during and after pregnancy.
  • Genital tract infections. The genital tract includes reproductive organs, like the vulva, vagina, uterus, fallopian tubes and ovaries. Signs and symptoms of genital tract infections may include fever, chills and pain in the lower belly.
  • Sepsis. Sepsis is the body’s extreme response to an infection. It can be life-threatening. Signs and symptoms of sepsis include fever, fast heart rate and fast breathing.

Non-cardiovascular medical conditions

These are medical conditions, like diabetes, kidney disease and pneumonia, that aren’t directly associated with the heart and blood vessels. You may have had the condition before you got pregnant. 

Amniotic fluid embolism

This is a rare condition that can happen during or right after birth. It’s when some of your baby’s cells or amniotic fluid (fluid that surrounds the baby in the womb) gets into your bloodstream. When this happens, your immune system may react, causing your blood to clot more than unusual. Tell your provider if you have signs or symptoms of amniotic fluid embolism, including: 

  • Shortness of breath
  • Feeling anxious (worried) 
  • Chills or a fast heart rate
  • Seizures
  • Bleeding from your vagina, from an incision (cut) from surgery or from the site where you have an IV (when you get fluid or medicine through a needle into a vein) 

How are mental health conditions involved in pregnancy-related death?

Mental health conditions affect your emotions, feelings and behaviors. They’re medical conditions that need treatment to get better. They can happen for the first during pregnancy and the postpartum period (the time right after you give birth), and they also can reoccur or happen again (called a relapse) during these times. Mental health conditions that affect pregnancy include:  

  • Depression (also called major depression). Depression is a medical condition that causes strong feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and last for a long time and can interfere with your daily life. 
  • Postpartum depression (also called PPD). PPD is a kind of depression some women get after having a baby. Depression is strong feelings of sadness, anxiety (worry) and tiredness that last for a long time after giving birth. These feelings can make it hard for you to take care of yourself and your baby.

Mental health conditions can lead to pregnancy-related death. Having an untreated mental health condition can make it hard for you to take care of yourself and your baby. You may not get the health care you need and take on unhealthy behaviors. These conditions can lead to things like substance use disorder, overdose, suicide or accidental death. Substance use disorders can happen when you use alcohol or drugs in a way that causes health problems or problems at work, school or home. An overdose is when you take too much of a drug. Overdose can cause serious medical problems and even death. Suicide is when a person kills herself. 

If you think you have a mental health condition, tell your health care provider. You can get treatment to make you feel better. If you’re being treated for a mental health condition before, during or after pregnancy, talk to your provider about any medicine you take. You and your provider can work together to decide about treatment options. It’s best to talk to your prenatal care and mental health providers about a treatment plan before you get pregnant.

What is a maternal near-miss?

Some women have conditions that can cause pregnancy-related death and survive them. This is sometimes called a maternal near-miss (also called severe maternal morbidity or SMM). It’s when a woman has unexpected and severe complications from labor and childbirth that cause serious short- or long-term health problems. In the United States, more women have a near-miss than die. For every death, there are about 100 women who have SMM. In 2014, more than 50,000 women in this country had SMM. 

If you’ve had a near-miss, you may have lots of different feelings. You may feel like you should be happy or grateful. Or you may have trouble dealing with what happened. You may feel sad, upset, worried, scared or angry. 

Some women who’ve had a near-miss have a condition called post-traumatic stress disorder (also called PTSD). This is a severe form of anxiety (strong feelings of worry or fear). PTSD may happen when you go through something shocking, scary or dangerous. If you have PTSD, you may feel stressed or scared even when you’re not in a dangerous situation. 

Signs and symptoms of PTSD include:

  • Serious anxiety
  • Flashbacks of the event. A flashback is when you relive a traumatic (scary or troubling) event so that it feels like the event is happening again. 
  • Nightmares
  • Physical responses (like sweating or a racing heartbeat) when you’re reminded of the event

If you think you have PTSD:

  • Tell your health care provider.
  • See a mental health professional. This is a person with training and education to help people with emotional or mental health conditions like PTSD. Mental health providers include social workers, therapists, counselors, psychologists, psychiatrists and psychiatric nurse practitioners. Ask your health care provider to help you find a mental health professional. 
  • Talk with family and friends about how you’re feeling.
  • Connect with other women and families who have had experiences like yours at Share Your Story, the the March of Dimes online community. 

Last reviewed: June, 2018

See also: Your checkup before pregnancyYour first prenatal care checkupWarning signs after birth