1. Maternal Mortality 2018: A Call to Action
Donald J. Dudley, M.D.
Department of Obstetrics and Gynecology
University of Virginia

2. Disclosures
I have no relevant disclosures.

3. A Historical and Cultural Perspective

5. Genesis 35:17-20
When her pangs were most severe, her midwife said to her, “Have no fear! This time, too, you have a son”. With her last breath—for she was at the point of death—she called him Ben-oni; his father, however, named him Benjamin. Thus Rachel died; and she was buried on the road to Ephrath [that is, Bethlehem]. Jacob set up a a memorial stone on her grave, and the same monument marks Rachel’s grave to this day.

6. Shah Jahan
Mumtaz Mahal

9. Martha Wayles Skelton Jefferson
Died September 6, 1782
Mary “Polly” Jefferson Eppes
Died April 17, 1804
Anne Randolph Bankhead
Died February 11, 1826

11. Padme Amidala

12. Tom Riddle, son of Merope Gaunt

14. But Why the Increase? The Causes of Maternal Death

15. Reasons for the Increase
Ascertainment Complexities
Delayed Childbearing
Obesity Epidemic
Increase in Cesarean Deliveries
Severity of Maternal Medical Conditions
Sem Perinatol 2012;36:14-18

16. In Maryland from (n=129),
38% of Maternal Deaths are Not
Reported on Death Certificates

18. Reasons for the Increase
Ascertainment Complexities
Delayed Childbearing
Obesity Epidemic
Increase in Cesarean Deliveries
Severity of Maternal Medical Conditions
Sem Perinatol 2012;36:14-18

20. Reasons for the Increase
Ascertainment Complexities
Delayed Childbearing
Obesity Epidemic
Increase in Cesarean Deliveries
Severity of Maternal Medical Conditions
Sem Perinatol 2012;36:14-18

21. Obesity and Maternal Death
Louis, et al. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, Sleep 2014;37:
Nationwide Inpatient Sample database
55 million hospital discharges
OSA related to Increased Odds:
Preeclampsia: 2.5 ( )
Eclampsia: 5.4 ( )
Cardiomyopathy: 9.0 ( )
Pulmonary Embolism: 4.5 ( )
In-hospital Mortality: 5 ( )

22. Reasons for the Increase
Ascertainment Complexities
Delayed Childbearing
Obesity Epidemic
Increase in Cesarean Deliveries
Unmasking of Maternal Medical Conditions
Sem Perinatol 2012;36:14-18

23. Clark, et al. Maternal death in the 21st century: causes, prevention, and
relationship to cesarean delivery. Am J Obstet Gynecol 2008;199:e1-36.

24. Reasons for the Increase
Ascertainment Complexities
Delayed Childbearing
Obesity Epidemic
Increase in Cesarean Deliveries
Severity of Maternal Medical Conditions
Sem Perinatol 2012;36:14-18

26. Hospitalization for Severe Maternal Morbidity: USA 1988-2011
Creanga, et al. Maternal Mortality in the United States:
Where are We Now? J Women’s Health 2014;23:3-9.

27. Prevention of Maternal Death
Systems-Based Approaches
Individual Measures

28. Maternal Mortality Review
Berg C. From identification to review to action—maternal mortality review
in the United States. Sem Perinatol 2012;36:7-13

29. History of Maternal Mortality Review in the USA
Marmol, et al. History of the Maternal Mortality Study Committees
In the United States. Obstet Gynecol 1969;34:

30. Maternal Mortality Review
Main E. Decisions required for operating a maternal mortality review committee:
the California experience. Sem Perinatol 2012:36:37-41