We reviewed maternal deaths in the state of Michigan occurring from 1972 through 1984. There were 15 maternal deaths in which anesthesia was considered the primary cause and 4 deaths in which anesthesia was a contributory factor. Complications of regional anesthesia were the main cause of death during the early part of the period, whereas the inability to accomplish endotracheal intubation emerged as the principal cause of death in recent years. Eleven of the 15 patients had undergone cesarean section. Obesity was a risk factor in 12 patients, in an equal number of patients the risk factor was the emergent nature of the operation, and hypertensive disease was a risk factor in eight. Thirteen of the 15 deaths occurred in black patients.
PIP: A review of all maternal deaths occurring in Michigan in 1972-84 uncovered 15 deaths in which anesthesia was considered the primary cause and an additional 4 deaths in which anesthesia was a contributory factor. Overall, anesthesia-related deaths contributed 6.9% of the direct maternal mortality in the state during the period under review. The mean age of the 15 women was 24 years (range, 16-34 years). 13 of the 15 deaths involved black women, resulting in an anesthesia-related mortality rate of 4.26/100,000 live births for blacks compared to only 0.14/100,000 among whites. The causes of deaths attributable to anesthesia were pulmonary complications in 1 case, cardiac complications in 9 cases, central nervous system complications in 2 cases, and reactions to spinal or lumbar puncture in 3 cases. Complications of regional anesthesia were the main cause of death during the early part of the study period, while the inability to accomplish endotracheal intubation has been the principal cause in recent years. 11 women had undergone cesarean section. Risk factors included obesity in 12 cases, the emergent nature of the operation in 12 cases, and hypertensive disease in 8 cases. All 3 of these risk factors were present in 40% of the women who died, at least 2 were present in 80%, and at least 1 was present in 93%. Specific steps recommended to reduce the incidence of anesthesia-related maternal mortality include the use of regional anesthesia where indicated, development of a plan to deal with airway problems, use of up-to-date equipment and monitoring instruments, and use of antacids.