FIGURE 1-2 Fetal and neonatal deaths: United States, 2000-2013. (Modified with permission from MacDorman MF, Gregory EC: Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep. 2015 Jul 23;64(8):1-24.) 32 weeks' gestation. Indeed, the percentage of infant deaths related to preterm birth increased from 34.6 percent in 2000 to 36.5 percent in 2005. When analyzed by birthweight, two thirds of infant deaths were in low-birthweight neonates. Of particular interest are infants with birthweights <500 g, for whom neonatal intensive care can now be ofered.
As shown in Figure 1-3, maternal mortality rates dropped precipitously in the United States during the 20th century. Pregnancy-related deaths are so uncommon as to be measured per 100,000 births. The CDC (2017a) has maintained data on pregnancy-related deaths since 1986 in its Pregnancy Mortality Surveillance System. In the latest report, Creanga and coworkers (2017) described 2009 pregnancy-related deaths during the period from 2011 to 2013. Approximately 5 percent were early-pregnancy deaths due to ectopic gestation or abortive outcomes. he deadly obstetrical triad ofhemorrhage, preeclampsia, and infection has accounted for a third of all deaths (Fig. 1-4). hromboembolism, cardiomyopathy, and other cardiovascular �CD ""..D
FIGURE 1-3 Maternal mortality rates for the United States, 19502003. (Data from Berg, 2010; Hoyert, 2007.) 11.4 �Yuf 11.8 �� � .��t ,��o
Cause of pregnancy-related deaths
FIGURE 1-4 Six common causes of pregnancy-related deaths for the United States, 2006-2010. (Data from Creanga, 2015.) disease together accounted for another third. Other signii-.
cant contributors were amnionic luid embolism (5.3 percent) and cerebrovascular accidents (6.2 percent). Anesthesia-related deaths were at an all-time low-only 0.7 percent. Similar causes were reported for selected cohorts for years 2008 to 2009 and 2013 to 2014 (MacDorman, 2017).
Shown in Figure 1-5, the pregnancy-related mortality ratio of 23.8 per 100,000 live births in 2014 is the highest during the previous 40 years. And, according to the Institute ofHealth Metrics, it was 28 per 100,000 in 2013 (Tavernise, 2016). This rise simply may be that more women are dying, however, other factors explain this doubling of the rate from 1990 to 2013 aoseph, 2017). The irst is an artiicial elevation caused by the International Statistical Classiication of Diseases, 10th Revision (ICD-I0), implemented in 1999. Second, improved ..C-) ) .=19
FIGURE 1-5 Estimated maternal mortality rates in 48 states and the District ofColumbia. (Data from MacDorman, 2016.)
Overview of Obstetrics 14.6 13.6