Maternal and perinatal deaths in California.
In a 29-month period, 151 of 373 deaths of California women occurring during or within 90 days of termination of pregnancy were studied jointly by the California Medical Association and the California State Department of Public Health. Twenty-two per cent of the deaths reviewed were considered unavoidable. In 74 per cent, one or more avoidable factors were identified. Avoidable factors could not be identified in 4 per cent of the cases.Thirty-three per cent of the cases considered to have avoidable factors were attributed to be solely the responsibility of the attending physician. Inadequate hospital facilities were held responsible in less than 1 per cent of deaths, while responsibility in 26 per cent of the deaths was laid directly to patient error or refusal. In 40 per cent of the avoidable deaths, more than one avoidable factor was identified. Nonobstetric conditions accounted for the greatest proportion of the deaths, followed by hemorrhage, toxemia of pregnancy, sepsis, abortion and ectopic pregnancy. The findings of this study compare closely with those of similar studies in other states, including Minnesota and Massachusetts.