Common Causes of Maternal Death
Globally, postpartum hemorrhage is the leading cause of maternal death, accounting for 27% of all maternal deaths worldwide, followed by indirect obstetric causes (23%) and hypertensive disorders (16%). 1
Global Perspective on Maternal Mortality
The distribution of maternal death causes varies significantly by geographic region and resource availability:
Hemorrhage remains the single most important contributor to maternal death globally, particularly in low-resource settings where 75% of maternal deaths are attributable to postpartum hemorrhage. 2, 3 The proportion of hemorrhage deaths is highest in sub-Saharan Africa and Western Asia and Northern Africa. 1
Cardiovascular disease has emerged as the largest single cause of maternal morbidity and mortality in high-resource countries, with no significant improvement over recent decades. 2 In developed nations like the UK, maternal mortality rates are 9.2 per 100,000 live births, compared to an estimated 216 per 100,000 globally. 2
Hypertensive disorders, especially preeclampsia, are responsible for approximately 14% of maternal deaths globally and represent the second leading cause of maternal mortality worldwide. 2 The proportion of maternal deaths from hypertensive disorders is highest in Latin America and the Caribbean. 1
Regional Variations in Cardiovascular Disease
The type of cardiovascular disease causing maternal death differs by development status:
In developed countries, congenital heart disease is the most common cardiovascular condition affecting pregnant women. 2
In developing countries, rheumatic valvular disease is the most prevalent cardiovascular condition contributing to maternal mortality. 2
Timing and Mechanisms of Death
Understanding when deaths occur is critical for prevention:
Most maternal deaths from hemorrhage and sepsis occur during the postpartum period, emphasizing the need for improved postpartum care in addition to intrapartum monitoring. 1
The highest risk for pulmonary embolism occurs immediately postpartum, with an incidence of 0.1-0.67 per 1000 pregnancies. 2
Emerging Contributors to Maternal Mortality
Several factors are increasingly recognized as significant contributors:
Maternal self-harm (suicide, injury, overdose) remains a leading yet underappreciated cause of maternal mortality, particularly in non-Hispanic White women. 2 In countries recording maternal suicides, the proportion ranges from below 1% to 26% of maternal deaths. 1
Substance use disorders have contributed to doubling of pregnancy-associated mortality involving opiates between 2007 and 2016, increasing from 4% to 10% of all maternal deaths. 2
Untreated or inadequately treated psychiatric illness results in poor prenatal care adherence, inadequate nutrition, and substance exposure, all contributing to maternal mortality risk. 2, 4
Critical Clinical Implications
The persistence of hemorrhage as the leading cause despite effective interventions available highlights:
The gap between evidence-based treatments and their implementation, particularly in resource-limited settings where hospital births have increased but access to emergency obstetric care, blood products, and therapeutic resources remain limited. 3
The need for improved access to quality healthcare, as hemorrhage deaths continue despite the existence of effective clinical interventions like tranexamic acid and oxytocin. 2, 1
Indirect causes of death require health system approaches to integrate obstetric and non-obstetric care, as these account for nearly one-quarter of maternal deaths. 1