Introduction: The most recent national report on maternal causes of death in Canada was published 15 years ago. This time lag is because surveillance is based on hospitalization data that do not include underlying causes of death information. We developed a new method to identify underlying causes of maternal death and conducted a 5-year review of maternal mortality.
Methods: All women who died in Canadian hospitals (excluding Quebec) while pregnant or within a year of delivery/termination of pregnancy in 2013/14-2017/18 were identified from the Discharge Abstract Database. Hospitalization records were used to constitute a sequential medical narrative, which served to identify and categorize the underlying cause of death according to the WHO framework. Deaths were classified as occurring within 42 days or up to a year after delivery.
Results: We identified 225 maternal deaths, of which 88 (39.1%) occurred within 42 days, 125 (55.6%) were late, and 12 (5.3%) were undetermined. Overall, 75 deaths (33.3%) were related to direct obstetric causes. Among deaths within 42 days, 59 (67.1%) were due to direct obstetric causes: 6 (6.8%) to abortive outcomes, 9 (10.2%) to hypertensive disorders of pregnancy, 14 (15.9%) to obstetric hemorrhage, 11 (12.5%) to pregnancy-related infection, and 25 (28.4%) to other obstetric complications and unanticipated complications of management. An underlying cause of death could not be determined in <5 (<6%) of such cases. Among late deaths, 11 (8.8%) were due to direct obstetric causes, such as intentional self-harm and peripartum cardiomyopathy. The most common indirect causes of death included malignancy (n=46, 49.5%) and diseases of the circulatory system (n=19, 20.4%).
Conclusion: A large proportion of maternal deaths in Canada, especially deaths within 42 days, are due to direct obstetric causes such as obstetric hemorrhage, infection, hypertension, and obstetric trauma. These causes may be preventable.
Arlin Cherian– Research Assistant, Department of Obstetrics and Gynaecology, Children's & Women's Health Centre of British Columbia; University of British Columbia; Women's Health Research Institute; BC Children's Hospital Research Institute
Jessica Liauw– Maternal-Fetal Medicine Fellow, University of British Columbia
Susie Dzakpasu– Senior Epidemiologist, Public Health Agency of Canada
KS Joseph– Professor, Department of Obstetrics and Gynaecology, Children's & Women's Health Centre of British Columbia; University of British Columbia; Women's Health Research Institute; BC Children's Hospital Research Institute