Violent maternal deaths in North Carolina

doi:10.1016/S0029-7844(99)00466-4

Obstetrics & Gynecology

Volume 94, Issue 6, December 1999, Pages 990-993

https://doi.org/10.1016/S0029-7844(99)00466-4 Get rights and content

Abstract

Objective: To describe the frequency of domestic violence and substance abuse among a series of injury-related maternal deaths, determine awareness of the obstetric provider of domestic violence in those deaths by intimate partner homicide or depression in those deaths by suicide, and examine the relative risk of violent maternal death for unmarried status and non-white race.

Methods: A follow-up investigation was carried out for a case series of 41 injury-related maternal deaths identified from 1992 to 1994 in North Carolina. Death certificates, police records, newspapers, and records from medical examiners were used to ascertain mechanism and intent, history of alcohol or drug abuse, and, in cases of homicide, the relationship of the perpetrator to the victim. The obstetric provider was asked about his or her knowledge of domestic violence, depression, and drug or alcohol abuse relevant to the deceased victim.

Results: A total of 21 women (51.2%) were known to have or suspected of having been abused by either an intimate partner or an acquaintance. Of the 41 women, 11 (26.8%) were known to have abused drugs and/or alcohol. The obstetric provider was aware or suspicious of abuse in one third of homicides committed by an intimate partner. In three of the five suicide deaths, the obstetric provider was aware of depression.

Conclusion: Domestic violence and drug and alcohol abuse were common in this series of injury-related maternal deaths. Domestic violence and depression were often unrecognized by the obstetric provider in these severe cases.

Section snippets

Materials and methods

The study was approved by the institutional review board and all identifying information was kept confidential. For the 3-year study period, 1992–1994, potential maternal deaths in North Carolina were identified using two methods of ascertainment. All death certificates from the State Department of Vital Records with an ICD-9 pregnancy-related code of 630-676, as determined by nosologists, and those with pregnancy mentioned on the death certificate were reviewed. In addition, the Perinatal

Results

For the 3-year period, 1992–1996, 62 women died either while pregnant or within 1 year of pregnancy termination or delivery from external causes of injury. Table 1 presents the matrix of mechanism by intent as recommended by the CDC for presenting external-cause injury mortality data. These 62 maternal deaths represent 38% of the total 167 maternal deaths identified during the study period. Twenty-two were homicides and five were suicides. Six deaths were cocaine related. Two deaths resulted

Discussion

This study describes the frequency of domestic violence and substance abuse in a series of injury-related maternal deaths during a 3-year period in North Carolina. The obstetric providers were surveyed to determine their awareness of abuse in cases of homicide by an intimate partner, and depression in cases of suicide. According to McFarlane, abuse begins prior to pregnancy for most women who are abused during pregnancy or in the postpartum period.7 It appears reasonable to assume that these

References (14)

A.L Dannenberg et al.
Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991
Am J Obstet Gynecol
(1995)
M Harper et al.
Maternal deaths due to homicide and other injuries in North Carolina1992–1994
Obstet Gynecol
(1997)
C.J Berg et al.
Pregnancy-related mortality in the United States, 1987–1990
Obstet Gynecol
(1996)
A.C Gielen et al.
Interpersonal conflict and physical violence during the childbearing year
Soc Sci Med
(1994)
H.K Atrash et al.
Maternal mortality in developed countriesNot just a concern of the past
Obstet Gynecol
(1995)
J Fields et al.
TraumaThe leading cause of maternal death
J Trauma
(1992)
B.P Sachs et al.
Maternal mortality in Massachusetts
N Engl J Med
(1987)

There are more references available in the full text version of this article.

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Original ArticlesViolent maternal deaths in North Carolina

Abstract

Section snippets

Materials and methods

Results

Discussion

Am J Obstet Gynecol

Obstet Gynecol

Obstet Gynecol

Soc Sci Med

Obstet Gynecol

TraumaThe leading cause of maternal death

J Trauma

Maternal mortality in Massachusetts

N Engl J Med

Original Articles
Violent maternal deaths in North Carolina