Injury-related maternal mortality

Abstract

OBJECTIVE:Prior studies on maternal mortality largely focused on deaths in the conventional time frame of 42 days after a live-birth delivery, often excluding women with a stillbirth. 1 Others relied on a pregnancy checkbox on the death certificate and then submitted to a central repository 2 or did not evaluate injury, 3 which has emerged as an important cause of late maternal death 43e365 days postpartum. 4 Herein we included stillbirths and provided more discrete time intervals to evaluate injury-specific causes of maternal mortality. STUDY DESIGN:We studied live births and stillbirths from 20 weeks' gestation onward, from 1990 through 2015, in Ontario, Canada, where health care is universally available. Provincial databases of all hospital deliveries and Vital Statistics, including mandatory completed death certificates, 5 were linked using unique encoded identifiers at the Institute for Clinical Evaluative Sciences. The Research Ethics Board of the Sunnybrook Health Sciences Centre granted ethics approval. Incidence rates (IRs) were separately calculated for injury and noninjury maternal deaths. IRs were shown across 11 time intervals within the 365 days after birth: biweekly from 0 to 42 days (when deaths are most common) and every 6 weeks thereafter. To account for the changing number of women at risk in each interval and the time at risk therein, IRs were presented per 1 million person-weeks, with 95% confidence intervals (CIs). The proportion of deaths caused by injury in each interval was also calculated and the corresponding trend tested by a 2sided Cochrane-Armitage test. Maternal deaths caused by injury at 0e42 and 43e365 days were presented by injury subtype: transport accident (International Classification of Diseases, ninth edition [ICD-9] E800eE849); accidental poisoning/overdose (ICD-9 E850eE854); intentional selfharm (ICD-9 E950eE959); assault/homicide (ICD-9 E960eE969); or other (ICD-9 E855eE949 and E970eE999).

Severe Maternal Morbidity and Infant Mortality in Canada

“…29,30 Sepsis, lethal congenital or chromosomal anomalies, and sudden infant death syndrome are causes of postneonatal death. 31 Recent discussion 32 and data 33 have emerged about an association between stillbirth and SMM, as well as the relation between stillbirth and maternal death after delivery. For example, among 3.2 million births in Ontario, the maternal mortality rate in the first year delivery was 206 per 100 000 stillbirths compared to 23 per 100 000 live births.…”

“…For example, among 3.2 million births in Ontario, the maternal mortality rate in the first year delivery was 206 per 100 000 stillbirths compared to 23 per 100 000 live births. 33 RR of infant death #365 days after birth, according to the presence or absence of SMM, further stratified by (A) maternal factors and (B) infant factors. All models were adjusted for maternal age, residential income quintile, rural residence, and world region of origin, each at the time of the index delivery, as well as maternal diabetes mellitus and chronic hypertension within 2 years before the index birth.…”

Development and internal validation of a model predicting severe maternal morbidity using pre-conception and early pregnancy variables: a population-based study in Ontario, Canada

“…A secondary outcome was all-cause maternal mortality, from birth until 365 days postpartum, since previous work has shown a persistent increase in mortality risk beyond the early postpartum period [ 22 , 23 ].…”

Postpartum self-inflicted injury, suicide, assault and homicide in relation to immigrant status in Ontario: a retrospective population-based cohort study

“…I ntentional injury, including suicide and assault, is a leading cause of morbidity and mortality for postpartum women, with potential for devastating consequences for women, children and families. 1 Suicidal thoughts are common among women after they give birth, affecting as many as 9% of women, 2 and suicide accounts for a high proportion of maternal deaths globally. 1,3,4 Assault, mainly by intimate partners, affects up to about 13% of women perinatally 5 and is also responsible for some maternal mortality.…”

“…1 Suicidal thoughts are common among women after they give birth, affecting as many as 9% of women, 2 and suicide accounts for a high proportion of maternal deaths globally. 1,3,4 Assault, mainly by intimate partners, affects up to about 13% of women perinatally 5 and is also responsible for some maternal mortality. [6][7][8][9] Immigrant women contribute one-quarter to one-third of births in high-income countries, 10 but their risk for intentional injury in the postnatal period is unknown.…”