The continuum of maternal morbidity and mortality: factors associated with severity

Am J Obstet Gynecol. 2004 Sep;191(3):939-44. doi: 10.1016/j.ajog.2004.05.099.


Objective: The goal of this study was to examine whether sociodemographic, clinical, and other service-related factors, as well as preventability issues affect a woman's progression along the continuum of morbidity and mortality.

Study design: This was a case-control study of pregnancy-related deaths, women with near-miss morbidity, and those with other severe, but not life threatening, morbidity. Factors associated with maternal outcome were examined.

Results: Provider factors (related to preventability) and clinical diagnosis were significantly associated with progression along the continuum after controlling for sociodemographic characteristics (P < .01 for both associations).

Conclusion: In order to improve mortality rates, we must understand maternal morbidity and how it may lead to death. This study shows that important initiatives include addressing preventability, in particular, provider factors, which may play a role in moving women along the continuum of morbidity and mortality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Case-Control Studies
  • Ethnicity
  • Female
  • Humans
  • Insurance, Health
  • Marital Status
  • Maternal Mortality*
  • Morbidity*
  • Odds Ratio
  • Parity
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / prevention & control
  • Racial Groups
  • Uterine Hemorrhage / diagnosis
  • Uterine Hemorrhage / mortality