Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Table 1
Defi nitions of maternal deaths
Maternal deaths* Deaths of women while pregnant or within 42 days of the end of the pregnancy † from
any cause related to or aggravated by the pregnancy or its management, but not
from accidental or incidental causes.
Direct* Deaths resulting from obstetric complications of the pregnant state (pregnancy,
labour and puerperium), from interventions, omissions, incorrect treatment, or from
a chain of events resulting from any of the above.
Indirect* Deaths resulting from previous existing disease, or disease that developed during
pregnancy and which was not due to direct obstetric causes, but which was
aggravated by the physiologic effects of pregnancy.
Late** Deaths occurring between 42 days and one year after abortion, miscarriage
or delivery that are due to Direct or Indirect maternal causes.
Coincidental (Fortuitous)*** Deaths from unrelated causes which happen to occur in pregnancy
or the puerperium.
Pregnancy-related deaths** Deaths occurring in women while pregnant or within 42 days of termination
of pregnancy, irrespective of the cause of the death.
† This term includes delivery, ectopic pregnancy, miscarriage or termination of pregnancy.
* ICD 9
** ICD 10
*** ICD 9/10 classifi es these deaths as Fortuitous but the Enquiry prefers to use the term Coincidental as it is a more
accurate description. The Enquiry also considers deaths from Late Coincidental causes.
Estimating maternal mortality ratios and rates
The international defi nition of the maternal mortality ratio (MMR) is the number of Direct and Indirect deaths
per 100,000 live births. In many countries of the world this is diffi cult to measure due to the lack of death
certifi cate data (should it exist at all) as well as a lack of basic denominator data, as baseline vital statistics
are also not available or unreliable. The recent World Health Organisation publication “Beyond The Numbers;
reviewing maternal deaths and disabilities to make pregnancy safer” 4 contains a more detailed examination
and evaluation of the problems in both determining a baseline MMR or interpreting what it actually means in
helping to address the problems facing pregnant women in most developing countries.
Conversely the UK has the advantage of accurate denominator data, including both live and still births and
has defi ned its maternal mortality rate as the number of Direct and Indirect deaths per 100,000 maternities.
Maternities are defi ned as the number of pregnancies that result in a live birth at any gestation or stillbirths
occurring at or after 24 weeks’ completed gestation and are required to be notifi ed by law. This enables a
more detailed picture of maternal death rates to be established and is used for the comparison of trends
over time.
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