Postdelivery mortality in Tennessee, 1989-1991

Objective: To describe postdelivery mortality rates among residents of Tennessee from 1989 through 1991 and to compare these rates with those of women who had not delivered a live or stillborn infant in the previous year. Methods: Postdelivery deaths (those occurring within a year of delivery of a live or stillborn infant) were identified using a computerized linkage of birth and fetal death certificates to death certificates of female decedents aged 15-44 years. Each identified postdelivery death was reviewed and categorized as either pregnancy-related (temporally and causally related to pregnancy) or pregnancy-associated-but-not-related (temporally but not causally related to pregnancy). Cause-specific mortality rates were compared for women who died postdelivery with women who died but had not delivered in the previous year. Results: We identified 129 postdelivery deaths, one quarter of which were classified as pregnancy-related. The rates of postdelivery pregnancy-related and of pregnancy-associated-but-not-related death were 14.6 and 58.7, respectively, per 100,000 women who had delivered. Nonwhite women were 6.9 times more likely to experience postdelivery pregnancy-related death and 2.0 times more likely to experience postdelivery pregnancy-associated-but-not-related death than were white women. The leading cause of death among both women who had delivered and women who had not delivered a live or stillborn infant in the previous year was injury, although the risk of death the year after delivery was lower than for women who had delivered. Conclusion: Women were less likely to die in the year after delivery than were women who had not delivered a live or stillborn infant in the previous year. However, regardless of their delivery status, injuries were the leading cause of death among women. Postdelivery mortality was statistically significantly higher in nonwhite than white women, especially for pregnancy-related deaths. (C) 1998 by The American College of Obstetricians and Gynecologists.