US pregnancy-related deaths caused by hemorrhage frequent, vary by race, ethnicity

Key takeaways:

• Overall, 11.4% of pregnancy-related deaths in the U.S. in 2012 to 2019 had an underlying cause of hemorrhage.
• The most frequent hemorrhage subclassifications varied by race and ethnicity.

Pregnancy-related deaths with an underlying cause of hemorrhage continue to be frequent, with the most common hemorrhage subclassifications varying by race and ethnicity, according to a research letter published in Obstetrics & Gynecology.

“Most pregnancy-related deaths with hemorrhage as an underlying cause of death are preventable,” Lisa M. Hollier, MD, MPH, senior medical advisor of the maternal mortality prevention team in the division of reproductive health at the National Center for Chronic Disease Prevention and Health Promotion at the CDC, and colleagues wrote. “The objective of this project was to provide additional details on pregnancy-related deaths for which hemorrhage was the Pregnancy Mortality Surveillance System-identified underlying cause of death in the United States from 2012 to 2019.”

Hollier and colleagues identified all 5,309 pregnancy-related deaths from the Pregnancy Mortality Surveillance System. Researchers estimated pregnancy-related mortality ratios for hemorrhage overall and by the hemorrhage subclassifications of ectopic pregnancy, postpartum hemorrhage, placenta accreta spectrum, abruption, previa, uterine rupture, other and unknown.

Overall, 11.4% of pregnancy-related deaths had an underlying cause of hemorrhage. Per 100,000 live births, overall pregnancy-related mortality ratio for 2012 to 2019 was 17 and 1.94 for pregnancy-related mortality ratio for hemorrhage overall.

Of pregnancy-related hemorrhage deaths, the most frequent subclassification was ruptured ectopic pregnancy (22.9%), followed by postpartum hemorrhage (21.2%) and placenta accreta spectrum (12.7%). The most frequent hemorrhage subclassification varied by race and ethnicity, with placenta accreta spectrum the most frequent for Hispanic deaths (20.6%), postpartum hemorrhage the most frequent for Asian deaths (37.8%) and ruptured ectopic pregnancy the most common for Black (32.6%) and white (23.4%) deaths.

Researchers observed no significant trends in pregnancy-related mortality ratio overall or for any hemorrhage subclassification from 2012 to 2019.

According to the researchers, the pregnancy-related mortality ratio for pregnancy-related deaths caused by hemorrhage of 1.9 per 100,000 live births remains “frequent.”

“Ruptured ectopic pregnancy and postpartum hemorrhage persist as significant contributors to pregnancy-related mortality due to hemorrhage. Subclassifications of hemorrhage deaths have different causes and different prevention opportunities,” the researchers wrote. “Reporting subclassifications of pregnancy-related hemorrhage deaths could improve the ability to focus interventions and identify progress over time.”