Objective:  To examine how review of all deaths of women occurring during pregnancy or within one year of pregnancy can reveal the prevalence of the association of pregnancy with violent deaths.

Design: Virginia’s Maternal Mortality Review Team (MMRT) is a multidisciplinary team that reviews all deaths of Virginia residents who were pregnant when they died or who died within one year of pregnancy regardless of the outcome of the pregnancy or the cause and manner of death, termed “pregnancy-associated death.”   The MMRT determined if each death was pregnancy-related and whether systems changes could be instituted to avert similar deaths.   A pregnancy-related death is a death resulting from:  1. Complications of the pregnancy itself; 2. the chain of events initiated by the pregnancy that led to death; or 3. Aggravation of an unrelated condition by the pregnancy that subsequently causes death.  The team determined if the death was pregnancy-related based on the circumstances surrounding each death.  Homicides and other violent deaths were characterized as pregnancy-related using the criteria that the chain of events initiated by the pregnancy led to death, e.g. through review of case facts that revealed the perpetrator of homicide was spurred to commit the homicide because of the pregnancy, or death investigation of a suicide revealed that the impetus was the pregnancy through notes referencing the pregnancy or through interviews with persons close to the victim.  This study reports on cases that were determined to be directly related to the pregnancy and describes the causes and manners of death.

Setting: Retrospective record review.

Patients/Participants: All women who died while pregnant or within one year of pregnancy.

Methods: Multiple case studies of the population of women who died within one year of pregnancy in a single state over a five year period.

Results:  Of the 210 pregnancy-associated deaths occurring from 1999 to 2003, 86 cases (40.9%) were determined to be pregnancy-related.  Leading causes and/or manner of pregnancy-related death were cardiovascular disorders (15.1%, n=13), pulmonary embolism (12.8%, n=11), cardiomyopathy (12.8%, n-11), hemorrhage (9.3%, n=8), homicide (8.1%, n=7), and suicide (7.0%, n=6).   More than one in five (22.1%) pregnancy-related deaths resulted from violence.     All but one violent death was considered to be preventable through changes in policy or practice.

Conclusion/Implications for nursing practice: Pregnancy may serve as a catalyst for violent death through several mechanisms. Reviewing deaths occurring during or near pregnancy reveals the magnitude of the problem and provides an opportunity to develop prevention and intervention strategies to reduce these deaths.

Keywords:  pregnancy-related death