Maternal mortality in North Carolina: a forty-year experience.

An analysis of 67 maternal deaths from January 1, 1981, through December 31, 1985, are reported in detail and in the perspective of 3780 maternal deaths previously reviewed in North Carolina since January 1, 1946. Although the direct obstetric mortality rate has decreased 95% over the 40 years, within causal mortality groups the rates have changed variably during the past 5 years. For the first time, no deaths from obstetric infection occurred. Whereas deaths from toxemia continue to decline, those from hemorrhage, embolism, and anesthetic complications remain unchanged. Within the hemorrhage causal group, deaths from ectopic pregnancy have risen to 70%. The maternal death rate after 20 weeks' gestation is almost 10 times that associated with pregnancy interruptions. Of particular concern is the relative risk of death between the nonwhite and white patients. The North Carolina data are reviewed in the light of those in the South Atlantic region and in the nation as a whole.