Objective: To assess trends in the maternal mortality ratio over a 10-year period in France and the causes, risk factors, quality of care, and avoidability of maternal deaths.
Methods: Maternal deaths up to 1 year after the end of the pregnancy from 1998 to 2007 were identified and studied through the French Confidential Enquiry Into Maternal Deaths system. Time trends were analyzed by comparing the two 5-year periods for maternal mortality ratios, both overall and by women's characteristics, causes of death, existence of suboptimal care, and avoidability.
Results: For the 10-year period, 660 maternal deaths were identified. The maternal mortality ratio was similar in the two 5-year periods, 8.8 per 100,000 live births (95% confidence interval [CI] 7.8-9.8) for 1998-2002 and 8.4 per 100,000 live births (95% CI 7.6-9.4) for 2003-2007. The distributions of maternal age, nationality, and of causes of death did not change. Overall, hemorrhage was the leading cause of death, responsible for 18% of maternal deaths, followed by amniotic fluid embolism, thromboembolism, hypertensive disorders, and cardiovascular conditions, each of which contributed to 10-12% of deaths. Suboptimal care decreased from 70% in 1998-2002 to 60% in 2003-2007 (P<.03). Half of all deaths were considered avoidable and this proportion did not change. The most frequent contributory factor was inadequate management.
Conclusion: The ratio and profile of maternal mortality in France remained unchanged from 1998 to 2007. Half of all maternal deaths are still considered avoidable, which indicates that improvement remains possible.
Level of evidence: : III.