Minnesota Maternal Mortality Study; five-year general summary, 1950-1954.

Abstract

The findings of the Minnesota Maternal Mortality Study 1950-1954 are reported. Attention is directed to the following: source of reporting of maternal deaths inaccuracies of death certificates and maternal mortality rates; causes of death; comments regarding care during the prenatal period; comments concerning care during labor delivery and postpartum state; and preventability and responsibility for death. 28% of the maternal deaths in Minnesota would have been missed had death certificate information alone been used since neither pregnancy nor the postpartum state were mentioned on the death certificate. Of these 78 deaths 37 (47%) were found by the cross-matching of birth and death certificates. 41 of the 78 deaths (52%) were discovered by other means such as notification by doctors and nurses. There seems to be no method of being assured that all these deaths are discovered unless all female deaths of the child-bearing age are investigated. Analysis of the maternal death certificates showed that only 35% were complete and correct. For the 5 year period of the study there were a total of 282 maternal deaths among 395558 live births for a gross mortality rate of 0.71/1000 live births. The gross maternal mortality rate in Minnesota has decreased by 76% during the past 14 years and the corrected obstetric mortality rate by 80%. Of the total maternal deaths 29% were considered preventable. Considering only the 177 obstetric deaths for the 5 year period 45% were regarded preventable. Hemorrhage was the leading cause of death accounting for 27% of the obstetric cases. Toxemia was the 2nd cause of death and 2/3 of these were due to eclampsia. Infection was the 3rd leading cause of death. Heart disease accounted for 7% of the obstetric deaths and anesthesia for 6%. Prenatal care as a whole was considered as faulty in 79% of the registered patients. In 16% of the cases the care was faulty and contributory to the patients death. Of the total deliveries 56% were by operative means. Of the 111 operative deliveries 32 were not indicated. 31 were by cesarean section. Of the 91 patients who died undelivered 14 were delivered by postmortem cesarean section but none of the infants survived. 79 (45%) of the obstetric deaths were considered preventable with physician responsibility assessed in 69 (87% of the preventable deaths). The hospital laboratory was assessed to be responsible in 2 instances due to errors in the cross matching of blood.