Maternal Deaths in Australia 1997–1999 MATERNAL DEATHS SERIES Number 1 Maternal Deaths in Australia 1997–1999 Emma K Slaytor Elizabeth A Sullivan James F King Contributing authors: Marie-Paule Austin, Michael Bennett, Georgina Chambers, Michael Humphrey, Michael Paech, Wendy Pollock, Gunapoopathy Ponnampalam, Barry Walters August 2004 Australian Institute of Health and Welfare Canberra AIHW cat. no. PER 24 © Australian Institute of Health and Welfare 2004 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Australian Institute of Health and Welfare. Requests and enquiries concerning reproduction and rights should be directed to the Head, Media and Publishing, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT 2601. This publication is part of the Australian Institute of Health and Welfare’s Perinatal Statistics Series. A complete list of the Institute’s publications is available from the Publications Unit, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT 2601, or via the Institute’s web site (http://www.aihw.gov.au). ISSN 1449-8863 ISBN 1 74024 392 7 Suggested citation Slaytor EK, Sullivan EA & King JF 2004. Maternal deaths in Australia 1997–1999. AIHW Cat. No. PER 24. Sydney: AIHW National Perinatal Statistics Unit. (Maternal Deaths Series No.1) Australian Institute of Health and Welfare Director Dr Richard Madden Published by AIHW National Perinatal Statistics Unit Printed by Union Offset Printers Contents List of tables ........................................................................................................................................vii List of figures ....................................................................................................................................... ix Preface..........................................................................................................................................................x Acknowledgements............................................................................................................................ xii Abbreviations..................................................................................................................................... xiii Key findings ....................................................................................................................................... xiv Section A Introduction ......................................................................................................................1 Aims of this report ................................................................................................................................2 Australian definitions of maternal mortality.....................................................................................3 1 Epidemiology of maternal deaths...................................................................................................6 Section B Direct maternal deaths ..................................................................................................13 2 Direct maternal deaths summary..................................................................................................14 3 Obstetric haemorrhage ...................................................................................................................17 4 Amniotic fluid and air embolism ..................................................................................................21 5 Thrombosis and thromboembolism..............................................................................................24 6 Hypertensive disorders in pregnancy ..........................................................................................27 7 Early pregnancy deaths ..................................................................................................................31 8 Deaths due to anaesthesia ..............................................................................................................33 9 Other direct maternal causes of death..........................................................................................36 Section C Indirect maternal deaths................................................................................................37 10 Indirect maternal deaths summary.............................................................................................38 11 Cardiac disease ..............................................................................................................................41 12 Deaths from psychiatric causes ...................................................................................................44 13 Other indirect causes of maternal death ....................................................................................49 Section D Incidental maternal deaths ...........................................................................................51 14 Incidental maternal deaths summary.........................................................................................52 15 Incidental causes of maternal death ...........................................................................................55 Section E Other key areas ...............................................................................................................59 16 Maternal mortality in Aboriginal and Torres Strait Islander women....................................60 17 Deaths associated with Caesarean section.................................................................................64 18 Epidemiology of maternal deaths in Australia 1973–99 ..........................................................69 19 Trends in reproductive health and maternity care in Australia, 1991–2000 .........................73 20 International comparisons............................................................................................................78 21 Data collection and classification issues.....................................................................................84 22 Recommendations for future reporting .....................................................................................90 v Section F Appendices .......................................................................................................................93 Appendix 1: Membership of the AIHW National Advisory Committee on Maternal Mortality ........................................................................................................................94 Appendix 2: Membership of AIHW National Advisory Committee Working Group..............95 Appendix 3: Membership of the State and Territory Maternal Mortality Committees 1997–99 ....................................................................................................96 Appendix 4: Method of enquiry........................................................................................................99 Appendix 5: National Maternal Death Reporting Form..............................................................101 Appendix 6: Statistical methods and classifications.....................................................................105 Appendix 7: Late maternal deaths..................................................................................................107 References...........................................................................................................................................109 vi List of tables Table D1: Classifications for maternal deaths occurring in Australia.........................................4 Table D2: Confinements by maternal age, Australia, 1997–99.....................................................5 Table 1.1: Maternal mortality ratios in each triennium, Australia, 1973–99...............................6 Table 1.2: Maternal death by age, 1997–99......................................................................................7 Table 1.3: Maternal death by residential region, 1997–99.............................................................8 Table 1.4: Gestational age and type of maternal death, 1997–99 .................................................8 Table 1.5: Stage of pregnancy at death by gestational age, 1997–99............................................8 Table 1.6: Birth outcomes, 1997–99...................................................................................................9 Table 1.7: Classification of maternal deaths, 1997–99....................................................................9 Table 1.8: Maternal mortality ratios by classification, 1973–99....................................................9 Table 1.9: Avoidable factors as determined by the State and Territory Committees, 1997–99 ......................................................................................................10 Table 1.10: Total deaths, age-specific and age-standardised maternal mortality rates— direct maternal deaths, 1997–99....................................................................................11 Table 1.11: Total deaths, age-specific and age-standardised maternal mortality rates— indirect maternal deaths, 1997–99 ................................................................................12 Table 1.12: Total deaths, age-specific and age-standardised maternal mortality rates— direct+indirect maternal deaths, 1997–99....................................................................12