Pregnancy-related death and health care services

To examine the association between health care services variables and pregnancy-related death using a contemporary geographically defined population and enhanced methods for case identification. This is a population-based, case-control study from North Carolina for the 7-year period 1992–1998. Pregnancy-related deaths after a live birth ( n = 118) were identified after review of pregnancy-associated deaths ( n = 400) ascertained from death certificate codes and linkage of birth and death files. Controls ( n = 3697) were randomly selected from all registered live births for the same 7-year period and were not matched with cases. This sample size was sufficient to ensure that the standard errors for subgroup prevalences were less than 1%. The associations between pregnancy-related death and health care services were explored with univariate and multivariable regression analysis. Neither maternity care coordination nor nutritional services were protective. There was no association with source of care, private versus public. The adjusted odds ratio (OR) for pregnancy-related death associated with cesarean delivery was 3.9 (95% confidence interval [CI] 2.5, 6.1). The adjusted OR for pregnancy-related death associated with the receipt of prenatal care was 0.2 (95% CI 0.1, 0.6). Removing barriers to and actively promoting use of prenatal care services and decreasing the rate of cesarean deliveries could decrease the number of pregnancy-related deaths.