Maternal Mortality Review and Classification


The definition of maternal mortality includes incidental deaths as defined below and deaths occurring after 42 days when the death was caused by pregnancy or its complications. The Queensland Maternal and Perinatal Quality Council also reviews 'late maternal deaths' of women between 43 days and 365 days after the end of their pregnancy.

  • Direct deaths are those which result from obstetric complications of the pregnant state (pregnancy, labour and puerperium) including interventions, omissions, inappropriate treatment, or from a chain of events resulting from any of these.
  • Indirect deaths are those which result from pre-existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiological effects of pregnancy
  • Incidental deaths are those in which pregnancy is unlikely to have contributed significantly to the death, although it is sometimes possible to postulate a distant association.

Reporting a maternal death in Queensland

The Public Health Act 2005, Chapter 6, Part 1A, 228F; Maternal Death Statistics Collection requires a health professional who had primary responsibility for the care or treatment of a woman while she was pregnant or within 365 days after the end of her pregnancy and is aware of the death of the woman, to give the chief executive of the Queensland Department of Health a notification about the death by completing the National Maternal Death Report Form.

Reviewing a maternal death in Queensland

De-identified information about a maternal death is given to members of the Maternity Mortality Sub-Committee for review. Each case is classified, a cause of death is assigned, and a judgement made as to the presence of avoidable factors.

A determination that avoidable factors were present does not imply that the death was certainly avoidable, but implies that there were aspects to the patient's care such that had a different course of action been taken, the risk of death might have been reduced. When avoidable factors are identified, they are further categorised into:

  1. factors associated with clinical care
  2. factors associated with the clinical service
  3. factors associated with the woman and/or her partner

Information on maternal deaths in Queensland is also submitted for inclusion in the National Reports on Maternal Mortality in Australia.

To enable the QMPQC to compile a comprehensive report on maternal deaths, the Chair of the Queensland Maternal and Perinatal Quality Council may contact relevant senior clinicians involved to request further information.

Last updated: 20 February 2018