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Park and Kwon: Analysis of the Causes and Trends of Maternal Mortality in Korea: 2009-2014
Original Article

Korean J Perinatol 2016;27(2):110-117.

Published online: 19 June 2016

DOI: https://doi.org/10.14734/kjp.2016.27.2.110

Analysis of the Causes and Trends of Maternal Mortality in Korea: 2009-2014

Hyun Soo Park, M.D., Ph.D., Hayan Kwon, M.D.

Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea

Correspondence to: Hyun Soo Park, M.D., Ph.D. Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10326 Korea Tel: +82-31-961-7367, Fax: +82-31-961-9309 E-mail: hsparkmd@dumc.or.kr

Received 18 March 2016       Revised 11 April 2016       Accepted 18 April 2016

Copyright © 2016 Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was conducted to analyze recent trends and causes of maternal mortality in Korea between 2009 and 2014.

Methods:

We investigated trends and causes of maternal death using the data from Complementary Investigations on the Infant, Maternal, and Perinatal Mortality carried out by Statistics Korea between 2009 and 2014. Maternal age, administrative district, causes of death and gestational age at the time of death were collected from data. Statistics including maternal mortality ratio (MMR) and maternal mortality rate were calculated. We also analyzed MMR according to the age, and administrative districts. The causes of maternal death were sorted and classified using International Classification of Diseases and World Health Organization recommendations.

Results:

The average MMR during 6 years was 13.16 and maternal mortality rate was 0.45. MMR was highest in 2011 (17.2) and lowest in 2012 (9.9). The average MMR of the administrative districts varied greatly from 7.51 (Gwangju) to 26.84 (Jeju). The average MMR during the study period was lowest in maternal age of 2024 (6.9), and highest in 45-49 (143.7). On average, direct and indirect maternal deaths accounted for 66.2% and 29.9% of total maternal death, respectively. The three most common causes of maternal deaths were obstetrical embolism (24.4%), postpartum hemorrhage (18.3%), and hypertensive disease of pregnancy (5.5%) in decreasing order of frequency.

Conclusion:

Although MMR is decreasing during the study period, it fluctuates widely according to maternal age, districts, and constant effort for improvements is necessary. To reduce maternal deaths, solution to control preventable causes of maternal deaths, careful management of pregnancies with advanced maternal age, and policy to solve the discrepancy in the medical services among diverse regions in the country are needed.

Keywords: Maternal death, Maternal mortality, Maternal mortality ratio, Maternal mortality rate, Cause of maternal death

REFERENCES

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Fig. 1
Average maternal mortality ratio between 2009-2014, according to maternal age.
kjp-27-110f1.tif
Fig. 2
Number of maternal death according to days from delivery from 2009 to 2014.
kjp-27-110f2.tif
Table 1.
Annual Number of Maternal Deaths, Maternal Mortality Ratio, and Maternal Mortality Rate
Year Maternal deaths No. of births MMRatio Women of reproductive age∗ MMRate
2009 60 444,849 13.49 13,460,879 0.45
2010 74 470,171 15.74 13,346,799 0.55
2011 81 471,265 17.19 13,215,176 0.61
2012 48 484,550 9.91 13,095,782 0.37
2013 50 436,455 11.46 13,001,758 0.38
2014 48 435,435 11.02 12,909,338 0.37

Abbreviations: MMRatio, maternal mortality ratio (number of maternal death/number of birth×100,000); MMRate, materna mortality rate (number of maternal death/number of women of reproductive age×100,000) ∗Mid-year population of 15-49 year old women

Table 2.
Maternal Mortality Ratio According to the Districts of Korea (2009-2014)
District 2009 2010 2011 2012 2013 2014 Average
Seoul 13.39 21.44 16.39 3.19 5.95 10.75 11.85
Busan 11.95 25.53 10.81 13.95 11.61 3.82 12.95
Daegu 30.93 19.46 14.45 13.97 10.34 15.50 17.44
Incheon 12.31 27.18 22.97 21.60 15.65 15.51 19.20
Gwangju 15.27 7.15 0.00 6.95 0.00 15.71 7.51
Daejeon 14.37 13.97 6.75 6.54 21.28 0.00 10.49
Ulsan 0.00 0.00 25.99 16.45 8.83 17.31 11.43
Gyeonggi 7.04 12.32 14.75 9.62 12.49 5.35 10.26
Gangwon 24.77 8.01 8.06 32.19 27.32 9.38 18.29
Chungbuk 28.77 13.63 13.51 6.61 14.64 14.96 15.35
Chungnam 36.35 39.52 24.51 9.78 21.47 16.48 24.69
Jeonbuk 26.26 6.21 18.55 6.16 6.87 14.05 13.02
Jeonnam 12.50 6.00 18.06 5.89 0.00 13.50 9.33
Gyeongbuk 8.94 12.66 28.87 16.24 13.51 27.20 17.90
Gyeongnam 3.30 3.11 24.59 6.02 13.56 10.08 10.11
Jeju 18.41 17.68 53.30 16.69 18.77 36.19 26.84
Total 13.49 15.74 17.19 9.91 11.46 11.02 13.13

The statistics of Sejong city was excluded in this table, as there has been no maternal death.

Table 3.
Common Causes of Maternal Deaths during 2009-2014
Major Causes 2009 2010 2011 2012 2013 2014 Total No (%)
Direct maternal death 41 43 50 31 36 38 239 (66.2)
Obstetric embolism (O88) 12 18 22 14 11 11 88 (24.4)
  O88.1 Amniotic fluid embolism 6 10 14 9 7 6 52
  O88.2 Obstetric blood-clot embolism 6 7 7 5 4 5 34
  O88.8 Other obstetric embolism 0 1 1 0 0 0 2
Postpartum hemorrhage (O62.2 O72) 15 11 10 6 9 15 66 (18.3)
  O62.2 Other uterine inertia 4 7 5 2 4 7 29
  O72.0 Third stage hemorrhage 2 0 0 1 0 0 3
  O721 Other immediate PPH 8 4 2 2 5 8 29
  O722 Delayed and secondary PPH 1 0 0 0 0 0 1
  O723 Postpartum coagulation defects 0 0 3 1 0 0 4
Hypertensive disorders (O10 ~ 16) 2 3 5 4 2 4 20 (5.5)
Indirect maternal death 15 29 25 17 12 10 108 (29.9)
Unspecified 4 2 6 0 2 0 14 (3.9)
Total 60 74 81 48 50 48 361
Table 4.
Grouping of Maternal Deaths According to WHO Recommendation
  2009 2010 2011 2012 2013 2014 Total
No (%)              
Direct maternal death 41 43 50 31 36 38 239 (66.2)
1. Pregnancies with abortive outcome 2 1 4 3 2 2 14 (3.9)
2. Hypertensive disorders in pregnancy, childhood, and the puerperium 2 3 5 4 2 4 20 (5.5)
3. Obstetric hemorrhage 20 18 13 8 15 18 92 (25.5)
4. Pregnancy-related infection 3 0 2 1 2 1 9 (2.5)
5. Other obstetric complications 13 20 26 15 15 13 102 (28.3)
6. Unanticipated complications of management 1 1 0 0 0 0 2 (0.6)
Indirect maternal death              
7. Non-obstetric complications 15 29 25 17 12 10 108 (29.9)
8. Unknown/undetermined 4 2 6 0 2 0 14 (3.9)
Total 60 74 81 48 50 48 361

∗O62.2 Other uterine inertia was included in group 3

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