Violent maternal deaths in North Carolina

Objective: To describe the frequency of domestic violence and substance abu se among a series of injury-related maternal deaths, determine awareness of the obstetric provider of domestic violence in those deaths by intimate pa rtner homicide or depression in those deaths by suicide, and examine the re lative risk of violent maternal death for unmarried status and non-white ra ce. 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 Caroli na. Death certificates, police records, newspapers, and records from medica l examiners were used to ascertain mechanism and intent, history of alcohol or drug abuse, and, in cases of homicide, the relationship of the perpetra tor to the victim. The obstetric provider was asked about his or her knowle dge 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 hav ing 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 obst etric provider was aware or suspicious of abuse in one third of homicides c ommitted by an intimate partner. In three of the five suicide deaths, the o bstetric provider was aware of depression. Conclusion: Domestic violence and drug and alcohol abuse were common in thi s series of injury-related maternal deaths. Domestic violence and depressio n were often unrecognized by the obstetric provider in these severe cases. (Obstet Gynecol 1999;94:990-3. (C) 1999 by The American College of Obstetri cians and Gynecologists.).