772: Maternal death in the maternal-fetal medicine unit cesarean registry

Abstract

772 Maternal death in the maternal-fetal medicine unit cesarean registry Lea Porche, Ibrahim Hammad, Malgorzata Mlynarczyk, James Hill, Bonnie Dattel, Suneet Chauhan Eastern Virginia Medical School, Obstetrics and Gynecology, Norfolk, VA OBJECTIVE: The primary purpose was to describe maternal death (MD) in the Maternal-Fetal Medicine Units (MFMU) Network Cesarean Registry; secondary purposes compared MD between African American (AA) vs. Caucasian (C); and MD vs. 24 hours after delivery. STUDY DESIGN: This is a secondary analysis of prospectively collected data for MFMU. Medical problems included asthma, cardiac, renal or connective tissue disease, chronic hypertension (HTN), or pregestational diabetes. Obstetric complications included abruption, gestational HTN, preeclampsia, eclampsia, HELLP, chorioamnionitis, or placenta accreta. Fisher exact test with approximation of Woolf or odd ratio (OR) with 95% confidence intervals (CI) was used. RESULTS: Of 73,257 births, there were 37 MD (50/100,000 births). All were singletons, 8% were 20 years old, 38% were nulliparous, and 41% were obese (body mass index 30 kg/m). Modes of delivery were: 57% primary cesarean, 35% repeat, and 8% trial of labor after cesarean. While 68% had no prior medical problems, 46% had no obstetric complications. The 3 leading initiating events for MM were hypertensive disease (32%), infection (16%) and cesarean delivery (16%); the 3 leading causes of death were cardiopulmonary arrest (43%), amniotic fluid embolism (13%) and intracranial hemorrhage (11%). The perinatal mortality was 81/1000 births. Maternal mortality rate among AA (79) was higher than C (44) but similar (OR 0.55; 95%CI 0.25, 1.20). Other factors did not differ significantly. Almost half of maternal deaths (49%) were 24 hours of delivery. Comparison of those who died vs. 24 hours of birth differed significantly for ethnicity (p 0.009) and ICU admission (28% vs. 63%, respectively; OR 0.16; 95% CI 0.04, 0.69). Other factors were not significantly different. CONCLUSION: Despite the small sample size, this prospectively collected database provides reliable data on the rate as well as causes of maternal death related to cesarean delivery in the US. Futures studies that include data from non-tertiary centers are needed.