This is the thirteenth triennial report on maternal deaths in Australia, presenting a summary of maternal deaths in Australia for the period 2000-2002. Death from pregnancy is rare in Australia compared to many countries in the region and the world. There were 95 maternal deaths reported to the AIHW National Perinatal Statistics Unit, of these 84 deaths were directly or indirectly related to or aggravated by the pregnancy or its management and occurred while the woman was pregnant or within 42 days of the termination of the pregnancy. Another three maternal deaths, known as incidental deaths were from accidental or incidental causes not related to the pregnancy or its management; and eight were late maternal deaths which occurred between 43 and 365 days post termination of pregnancy from causes related to or aggravated by the pregnancy or its management (Figure 1).

Figure 1: Relative proportion of maternal deaths by type of death, Australia, 2000-2002

pie chart showing for type of death by per cent (indirect 55; direct 34 ; late 8; incidental 3)

The figures presented in this report are not entirely comparable to previous reports because of continued improvements in ascertainment of maternal deaths and changes in the classification of deaths for some causes. This is most evident in the change in the distribution of indirect and incidental maternal deaths over the last two triennia (Table 1).

Table 1: Maternal deaths by type of death, Australia, 1997–2002

Type of death 1997-1999 2000-2002
Direct cause 34 32
Indirect cause 30 52
Incidental 28 3
Late 5 8
Total 97 95

The maternal mortality ratio (MMR) is the number of (direct and indirect) maternal deaths over the number of women who gave birth during the same time period. For the period 2000-2002 the MMR was 11.1 deaths per 100,000 women who gave birth. This is the highest recorded since the 1979-1981 triennium. However, there has been a change in classification of deaths from incidental to indirect for some causes in recent triennia. Also, there is fluctuation in the number of deaths from some causes over time due to small number variations and the sporadic nature of deaths. There has also been enhanced reporting of maternal deaths due to the inclusion of some conditions because of advances in the knowledge of their aetiology in relation to pregnancy. The age-specific MMR peaked at 32.8 per 100,000 women who gave birth for women aged 40-50 years and lowest for women aged 20-24 years (4.3 per 100,000 women who gave birth).

The major causes of direct and indirect maternal deaths were amniotic fluid embolism (AFE), haemorrhage from obstetric and other causes and cardiac disease and infection (Figure 2). The number of direct maternal deaths due to AFE increased from seven deaths in the 1997-1999 triennium to 10 in the 2000-2002 triennium. The number of indirect maternal deaths due to cardiac disease increased from seven deaths in the 1997-1999 triennium to 11 in the 2000-2002 triennium while those due to infection doubled from five deaths in the 1997-1999 triennium to 10 deaths in the 2000-2002 triennium.

Figure 2: Leading causes of direct and indirect maternal deaths, Australia, 2000-2002

2 horizontal bar charts showing (cause of direct death; cause of indirect death); cause on the y axis; number (0 to 12) on the x axis.

Mortality rates of Aboriginal or Torres Strait Islander women remained unacceptably high and were 4.5 times as high as for other women (MMR 34.8 deaths per 100,000 Indigenous women who gave birth versus 7.7 deaths per 100,000 other women who gave birth) when reported over the six year period 1997-2002. The very high mortality rates have been identified in previous reports. The 13 deaths identified in the 2000-2002 triennium were made up of one incidental and 12 direct and indirect deaths. This equalled one direct or indirect maternal death per 2,177 Aboriginal or Torres Strait Islander women who gave birth. The 2000-2002 triennium has seen a decline in maternal mortality due to hypertensive disorders, thrombosis and thromboembolism and motor vehicle accidents compared to the 1997-1999 triennium. Deaths from motor vehicle accidents decreased from six in the previous triennium to one during the 2000-2002 triennium.