ANESTHESIA-RELATED DEATHS DURING OBSTETRIC DELIVERY IN THE UNITED-STATES, 1979-1990

Background Anesthesia-related complications are the sixth leading caus e of pregnancy-related death in the United States. This study reports characteristics of anesthesia-related deaths during obstetric delivery in the United States from 1979-1990. Methods: Each state reports deat hs that occur within 1 yr of delivery to the Centers for Disease Contr ol and Prevention as part of the ongoing Pregnancy Mortality Surveilla nce. Maternal death certificates (with identifiers removed) matched wi th live birth or fetal death certificates when available from 1979-199 0 were reviewed to identify deaths due to anesthesia, the cause of dea th, the procedure for delivery, and the type of anesthesia provided. M aternal mortality rates per million live births were calculated, Case fatality rates and risk ratios were computed to compare general to reg ional anesthesia for cesarean section deliveries. Results: The anesthe sia-related maternal mortality rate decreased from 4.3 per million liv e births in the first triennium (1979-1981) to 1.7 per million in the last (1988-1990), The number of deaths involving general anesthesia ha ve remained stable, but the number of regional anesthesia-related deat hs have decreased since 1984. The case-fatality risk ratio for general anesthesia was 2.3 (95% confidence interval [CI], 1.9-2.9) times that for regional anesthesia before 1985, increasing to 16.7 (95% CI, 12.9 -21.8) times that after 1985. Conclusions: Most maternal deaths due to complications of anesthesia occurred during general anesthesia for ce sarean section. Regional anesthesia is not without risk, primarily bec ause of the toxicity of local anesthetics and excessively high regiona l blocks. The incidence of these deaths is decreasing, however, and de aths due to general anesthesia remain stable in number and hence accou nt for an increased proportion of total deaths, Heightened awareness o f the toxicity of local anesthetics and related improvements in techni que may have contributed to a reduction in complications of regional a nesthesia.