Maternal mortality in Iowa from 1952 to 1986.

The frequency of maternal death is decreasing in Iowa, particularly in the category of direct obstetric causes, such as hemorrhage, infection, pre-eclampsia and eclampsia. Unfortunately, concurrent linkage of vital statistics records was not performed during the study period, precluding any certain conclusion that all maternal deaths were actually identified (29). In addition, there has been, at best, only a modest decrease in the proportion of direct obstetric deaths that are preventable, suggesting that the educational goals of the maternal mortality review process are as yet far from fulfilled. In particular, the number of embolic deaths, both from pulmonary emboli and amniotic fluid emboli, has remained constant. We now appreciate many predisposing risk factors for pulmonary embolization and must seriously consider prophylactic anticoagulation in pregnant or puerperal women at increased risk. We also need further studies in the pathogenesis, treatment and prevention of amniotic fluid emboli. Although associated with lower proportions of preventability than with direct causes of obstetric deaths, the indirect and nonobstetric categories of maternal deaths have also been associated with a less dramatic decline in numbers. In particular, trauma remains a persistent cause of preventable maternal death. Continued public education as well as legislation for mandatory safety restraints in automobiles may reverse this trend. This suggests that considerable room for improvement exists in the field of education of patients and of health care professionals who routinely care for patients with complicated obstetric problems.