Key findings

  • There were 90 maternal deaths in the triennium 1997-99, and there were 758,030 confinements, indicating one maternal death per 8,423 confinements.
  • The maternal mortality ratio (MMR) of 8.2 deaths per 100,000 confinements, while not as low as the ratio for 1991-93, is a return to the steady decline of the MMR in the past 24 years.
  • The risk of death was highest for women aged 40-44 years who had an MMR of 23.2 deaths per 100,000 confinements and lowest for women aged 20-24 years who had an MMR of 4.0 deaths.
  • There were 34 direct maternal deaths, compared with 46 deaths in the previous triennium; 71% of direct deaths occurred at a gestational age of 37 weeks or more.
  • There were no deaths due to termination of pregnancy during this triennium.
  • There were 28 indirect maternal deaths, compared with 20 in the previous triennium. This increase is partially a result of a change in classification practice, with deaths due to psychiatric causes now being classified as indirect rather than incidental.
  • Incidental deaths are no longer included in the MMR calculation but are considered to be an important category of maternal mortality and will continue to be routinely collected. There were 28 incidental deaths compared with 34 in the previous triennium.
  • The most common cause of direct death was obstetric haemorrhage (eight deaths) compared with five from the previous triennium. This category continues to be of concern and may be increasing. The other most common causes of direct death were amniotic fluid embolism, pulmonary thromboembolism and hypertensive disorders.
  • The most common category of indirect death was death due to psychiatric causes (eight deaths). The change in classification of these deaths from incidental to indirect reflects increasing concern about the contribution of psychiatric disorders to maternal mortality, for which preventive strategies are being evaluated.
  • The most common causes of incidental death were deaths from motor vehicle accidents, deaths due to infection and drug-related deaths. These categories often present opportunities for prevention.
  • There is a need to implement a systematic process for considering and reporting the presence of potentially avoidable factors by the State and Territory Committees.
  • The MMR for Aboriginal and Torres Strait Islander women continues to be higher than the rate for non-Indigenous women. In the current triennium, the MMR for Aboriginal and Torres Strait Islander women was 23.5 deaths per 100,000 confinements compared with 7.2 for non-Indigenous women. There is justification for continuing concern about this disparity.
  • The reduced health status of the Aboriginal and Torres Strait Islander community is reflected in the threefold higher MMR; severe co-morbidities were present in five of the seven Aboriginal and Torres Strait Islander maternal deaths.
  • There is a need for improvement in the ascertainment of Indigenous status in maternal mortality surveillance.
  • Evidence-based clinical practice guidelines are available for prevention and management of several of the major obstetric complications and should be uniformly utilised in Australian maternity institutions.
  • 59% of direct maternal deaths and 54% of indirect maternal deaths were the subject of coronial inquests indicating suboptimal coronial referral practices.