248: Leading causes of maternal mortality at an inner-city Hospital, 1949-2017

The purpose of this study was to characterize the causes of pregnancy-related and pregnancy- associated maternal deaths at a large safety-net hospital from 1949 - 2017 Death summaries, autopsy reports and previously collected data were reviewed for maternal deaths for time intervals spanning from January 1949 through December 2017. The intervals assessed were 1949-1971 (Interval 1) and 1972-2017 (Interval 2). The causes and incidence of pregnancy-related and pregnancy-associated deaths were ascertained and specified as: hemorrhage, cardiovascular disease, cardiomyopathy, hypertensive disorders of pregnancy, other medical non-cardiovascular disease, infection/sepsis, accidental, homicide and suicide. Chi-square and Fisher exact test were used to test the relationship between time intervals and causes of death. The leading cause of pregnancy-related deaths in interval 1 was infection/sepsis, accounting for 27%. The leading cause of pregnancy-related death in interval 2 was hypertensive disorders of pregnancy, accounting for 23% of pregnancy-related deaths. The percentage of pregnancy-related deaths due to infection/sepsis dropped significantly (p < .001) between the time intervals from 27% to 7%. The leading cause of pregnancy-associated deaths in interval 1 was accidental deaths, accounting for 21% of deaths, and was homicide during interval 2, accounting for 28% of pregnancy-associated deaths. The percentage of pregnancy-associated deaths due to homicide increased significantly (p < .05) between the time intervals from 9% to 28%. Over time, there has been a decrease in pregnancy-related deaths due to infectious causes, and an increase in pregnancy-associated deaths due to homicides at our hospital. The increase in deaths from homicide highlights the importance of screening for domestic violence and promoting public health initiatives to improve safety. The decrease in deaths due to infections points to successful intervention and subsequent reduction of a major contributor to maternal mortality. Since 1972, the leading cause of pregnancy-related deaths in our hospital is hypertensive disorders of pregnancy. This warrants further investigation and implementation of effective protocols to prevent maternal deaths related to hypertensive disorders of pregnancy.