Maternal deaths in Australia 2021–2023

In this section, some data are presented as aggregated over a decade (2014–2023), in addition to results for the most recent triennium (2021–2023). This is due to the relatively small number of maternal deaths in each causal group and to allow more detailed and meaningful analyses.

Maternal deaths across triennia

Looking back to when comparable definitions were introduced in 1973–1975, the major causes of maternal death were sepsis, cardiovascular disease, hypertensive disorders, obstetric haemorrhage, and thromboembolism. The MMR for these conditions has been falling over time. This is consistent with the overall decrease in MMR in Australia from 12.7 in 1973–1975 to 6.7 in 2021–2023 (see Figure 2.1).

Using data from when the NMMDC began in 2006, Figure 5.4 presents the MMR by cause of maternal death to monitor rates by different causes of death over time. This figure shows that while some causes, for example cardiovascular disease, have been consistently common over time, there are fluctuations across causes and reporting periods.

Caution should be taken when interpreting these data over time due to the small number of maternal deaths in each causal group per triennium.

Maternal deaths in the most recent decade

In the decade from 2014 to 2023, there were 197 maternal deaths. The most frequent causes of maternal death reported in Australia between 2014 and 2023 were:

• For all maternal deaths:
  • cardiovascular disease (27 deaths or 14%)
  • sepsis (24 deaths or 12%)
  • suicide (20 deaths or 10%)
  • thromboembolism (obstruction of a blood vessel by a blood clot) (19 deaths or 10%)
• For direct maternal deaths:
  • thromboembolism (obstruction of a blood vessel by a blood clot) (18 deaths)
  • amniotic fluid embolism (significant amounts of amniotic fluid entering the maternal circulation) (17 deaths)
  • sepsis (14 deaths)
  • suicide (8 deaths)
• For indirect maternal deaths:
  • complications of pre-existing cardiovascular disease (24 deaths)
  • substance use complications (15 deaths)
  • non-obstetric haemorrhage (mostly haemorrhage within the brain and haemorrhage from a ruptured aneurysm of the splenic artery) (13 deaths)
  • suicide (12 deaths). 

See Figure 5.5 to explore all causes of maternal death by classification for this period. There is further information presented on causes of maternal deaths by decade in the annual Maternal deaths in Australia update in Australia’s mothers and babies.

Thromboembolism

Deaths caused by thromboembolism result from blood clots obstructing major blood vessels. The most common example is pulmonary thromboembolism with obstruction of the major pulmonary arteries.

The MMR for maternal deaths caused by thromboembolisms has decreased from 1.5 in 1973–1975 to 0.3 in 2021–2023 (see supplementary table 20 – Data tables: Maternal deaths in Australia, 2021–2023). When interpreting the trend in the rate of maternal deaths due to thromboembolism, it may be useful to consider the impact of National guidelines such as the Venous Thromboembolism Prevention Clinical Care Standard (ACSQHC 2020), which would be anticipated to help improve rates of thromboembolism.

In 2021–2023:

• 3 mothers died due to thromboembolism, an MMR of 0.3; all of these deaths were classified as direct
• 2 of these deaths were due to pulmonary thromboembolism (see supplementary tables 14, 15 and 20 – Data tables: Maternal deaths in Australia, 2021–2023).

In the decade 2014–2023, 19 mothers (9.6%) died from thromboembolism, making it the 4th most frequent cause of maternal death for this period (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to thromboembolism have fluctuated over time, see Figure 5.4.

In most cases, information was not available about the use of preventive measures, such as thromboprophylaxis and/or thrombolysis, however factors such as the inappropriate dosage of anticoagulant medicines such as Clexane may be a factor in deaths caused by thromboembolism (ACSQHC 2021).

Cardiovascular disease

Deaths caused by cardiovascular disease commonly originate from either new or existing disease processes in the heart or major blood vessels. New disease processes include cardiomyopathy of pregnancy (inflammation of the heart muscle). Existing disease processes include congenital heart malformations and rheumatic heart valve lesions.

Cardiovascular disease is one of the most common causes of death during pregnancy in industrialised countries. Pregnancy might reveal or exacerbate previously undiagnosed cardiovascular disease, due to the physiological changes that occur. Older mothers are at increased risk of heart disease, especially when obesity, smoking, diabetes, and hyperlipidaemia (high blood lipid levels) coexist with advanced maternal age.

The MMR for maternal deaths caused by cardiovascular disease has decreased from 2.2 in 1973–1975 to 0.8 in 2021–2023 (see supplementary table 20 >– Data tables: Maternal deaths in Australia, 2021–2023); however, despite this decrease it remains one of the leading causes of maternal death.

In 2021–2023:

• 7 mothers died from cardiovascular disease, an MMR of 0.8 (see supplementary tables 14 and 20 – Data tables: Maternal deaths in Australia, 2021–2023). All of these were indirect deaths making complications of pre-existing cardiovascular disease  the most common cause of indirect maternal death for this period (see supplementary table 14 – Data tables: Maternal deaths in Australia, 2021–2023).
• One of these deaths was due to an arrhythmic event, 2 were due to aneurysms, and 1 was due to pulmonary capillary hemangiomatosis. Additional information on the remaining 3 deaths due to cardiovascular disease was not provided to the NMMDC.

In the decade 2014–2023, 27 mothers (14%) died from cardiovascular disease (3 direct and 24 indirect), making it the most frequent cause of maternal death for this period (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to cardiovascular disease have fluctuated over time, see Figure 5.4.

Sepsis

Deaths caused by sepsis begin with infection. Infection might arise from complications of the pregnancy, such as retained products of conception after an early pregnancy loss, chorioamnionitis in late pregnancy, or infection elsewhere in the mother’s body.

The MMR for maternal deaths caused by sepsis decreased from 3.2 in 1973–1975 to 0.8 in 2021–2023 (see supplementary table 20 – Data tables: Maternal deaths in Australia, 2021–2023). However, despite this decrease sepsis remains one of the most common causes of maternal death in Australia. When interpreting the trend in the rate of maternal deaths due to sepsis, it may be useful to consider the impact of initiatives to improve the recognition and management of sepsis in health care settings, such as the 2023 position statement for the investigation and management of sepsis in pregnancy, from the Society of Obstetric Medicine of Australia and New Zealand (Bowyer et al 2025).

In 2021–2023:

• 7 mothers died from sepsis, an MMR of 0.8 (see supplementary tables 14 and 20 – Data tables: Maternal deaths in Australia, 2021–2023).
• 2 of these septic deaths were related to Group A Streptococcus, 1 was due to acute myometritis, 1 was due to bronchopneumonia, 1 was due to a disseminated fungal infection and 1 was due to septicaemia of unknown cause. Additional information about the remaining 1 death due to sepsis was not provided to the NMMDC.

In the decade 2014–2023, 24 mothers (12%) died from sepsis, making it the second most frequent cause of maternal death for this period (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to sepsis have fluctuated over time, see Figure 5.4.

Amniotic fluid embolism

Deaths caused by amniotic fluid embolism start with the effects of amniotic fluid, fetal cells or debris entering the maternal circulation, leading to severe shock, obstructed pulmonary blood flow, poor oxygen exchange, and severe clotting failure. Diagnosis is usually possible only by microscopic demonstration at autopsy, of fetal cells and other debris within the mother’s major blood vessels, and can only be made once other potential primary causes have been excluded (Dildy et al 2024). This is an example of why autopsy is so important in determining the cause of death.

There has been little change in the MMR for maternal deaths caused by amniotic fluid embolism from 1973–1975 to 2021–2023 (MMR 0.7 and 0.7 respectively). In 2021–2023, 6 mothers died from amniotic fluid embolism (see supplementary tables 14 and 20 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to amniotic fluid embolism have fluctuated over time, see Figure 5.3.

In the decade 2014–2023, 16 mothers (8.2%) died from amniotic fluid embolism (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to amniotic fluid embolism have fluctuated over time, see Figure 5.4.

Substance use complications

Deaths caused by complications arising from substance use are associated with the effects of alcohol or other drug use, as determined by toxicology or pathology reports.

Substance use complications have not been reported consistently since 1973 and this prevents a long-term comparison between triennia, however, fluctuations in the maternal death rate due to substance use complications from 2006 can be explored in Figure 5.4.

Historically, some deaths due to substance use complications may have been classified as coincidental to pregnancy, so were not counted as maternal deaths, though if the available information suggested that pregnancy might have been influential in the death, it may have been classified as an indirect maternal death. The classification of historical deaths due to substance use complications have been reviewed and updated as indirectly related to pregnancy where applicable (see Technical notes for further detail). 

In 2021–2023:

• There were 3 maternal deaths due to substance use complications, an MMR of 0.3 (see supplementary table 14 – Data tables: Maternal deaths in Australia, 2021–2023).
• Deaths due to substance use complications were related to the use of a variety of substances, including gamma-hydroxybutyrate

In the decade 2014–2023, 15 mothers (7.7%) died from substance use complications (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023).

Suicide

Deaths categorised as suicide are those where the available evidence suggested that the woman died as a result of intentional self-harm. Maternal deaths by suicide are classified as direct maternal deaths where maternal mental health issues that first presented during pregnancy were identified, and as indirect maternal deaths where a mental health condition was identified before the pregnancy (see Technical notes for further detail).

There has been little change in the MMR for maternal deaths by suicide from 1973–1975 to 2021–2023 (MMR 0.7 and 0.5 respectively). In 2021–2023 there were 4 maternal deaths by suicide (see supplementary tables 14 and 20 – Data tables: Maternal deaths in Australia, 2021–2023).

In the decade 2014–2023, there were 19 maternal deaths (10%) by suicide recorded (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to suicide have fluctuated over time, see Figure 5.4.

Non-obstetric haemorrhage

Deaths caused by non-obstetric haemorrhage start with bleeding arising from maternal blood vessels that are not within the genital tract. Most maternal deaths that fall into this category are related to intracerebral haemorrhage or rupture of an aneurysm of the splenic artery.

Intracerebral haemorrhage occurs when a blood vessel within the brain bursts, allowing blood to leak into the brain. The cause of splenic artery aneurysm, and the strong association of aneurysm rupture with pregnancy, is unclear (Sadat et al. 2008). Pregnancy hormones and increased cardiac output have been suggested as increasing the likelihood of aneurysm formation and/or rupture during pregnancy, by respectively weakening the arterial wall and increasing the blood pressure.

There is no clear long-term trend in the MMR for maternal deaths caused by non-obstetric haemorrhage over time (1.0 in 1973–1975, 0.9 in 2021–2023); however, the MMR in 2021–2023 was three times as high as in the preceding 2 triennia (MMR of 0.3 in both 2015–2017 and 2018–2020). See supplementary table 20 – Data tables: Maternal deaths in Australia, 2021–2023.

In 2021–2023:

• there were 8 maternal deaths due to non-obstetric haemorrhage, an MMR of 0.9
• 3 of these deaths were caused by intracranial haemorrhage, 3 by rupture of the splenic artery, 1 by intracerebral haemorrhage and 1 by cerebrovascular haemorrhage (see supplementary tables 14-16, and 20 – Data tables: Maternal deaths in Australia, 2021–2023).

In the decade 2014–2023, 18 mothers (9.1%) died from non-obstetric haemorrhage (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to non-obstetric haemorrhage have fluctuated over time, see Figure 5.4.

Obstetric haemorrhage

Deaths caused by obstetric haemorrhage start with bleeding from the genital tract including the uterus, either during pregnancy or following birth. 

Deaths due to obstetric haemorrhage have been declining in Australia over the past 30 years - the advent of oxytocic drugs over the last 3 decades has contributed to the reduction in this pregnancy complication (Begley et al. 2019). Over the long-term, deaths due to obstetric haemorrhage have fallen from an MMR of 1.7 in 1973–1975, to 0.5 in 2021–2023 (see supplementary tables 14, 15 and 20 >– Data tables: Maternal deaths in Australia, 2021–2023). 

In 2021–2023: 

• 4 mothers died due to obstetric haemorrhage, an MMR of 0.5 
• 2 deaths were related to uterine rupture and 1 death was caused by postpartum haemorrhage. Information on the specific cause of death was not available for the fourth death (see supplementary tables 14 and 20 – Data tables: Maternal deaths in Australia, 2021–2023)..

In the decade 2014–2023, 10 mothers (5.1%) died from obstetric haemorrhage (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to obstetric haemorrhage have fluctuated over time, see Figure 5.4

Hypertensive disorders

Deaths caused by hypertensive disorders start with the effects of raised blood pressure. The most common deaths in this category relate to pre-eclampsia and its complications, such as Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome and intracerebral (within the brain) haemorrhage.

The MMR for maternal deaths caused by hypertensive disorders decreased from 2.0 in 1973–1975 to 0.3 in 2021–2023 (see supplementary table 20 – Data tables: Maternal deaths in Australia, 2021–2023).

In 2021–2023:

• 3 mothers died due to hypertensive disorders, an MMR of 0.3 (see supplementary tables 14-16and 20 – Data tables: Maternal deaths in Australia, 2021–2023).
• One death was caused by eclampsia and one was related to chronic hypertension. Information on the specific cause of death was not available for the third death.

In the decade 2014–2023, 7 mothers (3.6%) died from hypertensive disorders (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to hypertensive disorders have fluctuated over time, see Figure 5.4.

Ectopic pregnancy

An ectopic pregnancy is where a fertilised egg implants at a site other than in the uterus, most commonly in the fallopian tube. If not treated, ectopic pregnancies can rupture, causing internal bleeding, infection, and potentially death.

In 2021–2023, 1 mother died due to an ectopic pregnancy, an MMR of 0.1 (see supplementary table 14 – Data tables: Maternal deaths in Australia, 2021–2023).

In the decade 2014–2023, 3 mothers (1.5%) died from ectopic pregnancy (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to ectopic pregnancy have fluctuated over time, see Figure 5.4.

Homicide

Deaths included in this category are those where the available evidence suggested that the woman was killed by another person. Deaths due to homicide are often classified as coincidental to pregnancy, so are not classified as maternal deaths. But if the available information suggests that pregnancy might have been influential in the death, it may be classified as an indirect maternal death. 

In 2021–2023, 3 mothers died from homicide, an MMR of 0.3. These indirect maternal deaths were related to domestic violence (see supplementary tables 14 and 16  – Data tables: Maternal deaths in Australia, 2021–2023).

In the decade 2014–2023, 10 mothers (5.1%) died from homicide (see supplementary table 21 – Data tables: Maternal deaths in Australia, 2021–2023). To further explore how rates of maternal death due to homicide have fluctuated over time, see Figure 5.4. 

Other causes of maternal deaths

Supplementary tables 14–16 provide information about causes of death, with 1 direct and 6 indirect maternal deaths being from other causes in 2021–2023 (Data tables: Maternal deaths in Australia, 2021–2023). The cause of the direct death was uterine torsion, while cause of death was only available for 3 of the 6 indirect deaths (asthma (2 deaths), and acute ischaemic bowel disease (1 death)).