WASHINGTON, Oct 13 (Reuters) - The United States has a sharply higher rate of women dying during or just after pregnancy than European countries, even some relatively poor countries such as Macedonia and Bosnia, according to the first estimates in five years on maternal deaths worldwide.

The report released by various United Nations agencies and the World Bank on Friday shows that Ireland has the lowest rate of deaths, while several African countries have the worst.

The United States has a far higher death rate than the European average, the report shows, with one in 4,800 U.S. women dying from complications of pregnancy or childbirth, the same as Belarus and just slightly better than Serbia's rate of one in 4,500.

Just one out of 47,600 women in Ireland die during or just after childbirth, the report found. Bosnia had the second-lowest rate, with 1 in 29,000 women dying during pregnancy and childbirth.

"Among the ten top-ranked European and other industrialized countries, where women are guaranteed good-quality health and family planning services that minimize their lifetime risk, fewer than one in 16,400 will die from complications of pregnancy and childbirth," the United Nations, which issued the report along with the World Bank, said in a statement.

"At the other end of the scale are ten countries where high fertility and shattered health care systems raise women's lifetime risk so that more than one in every 15 women will die of pregnancy-related causes," it said.

The report, published in the Lancet medical journal, places the United States 41st among 171 countries.

The four lowest-ranked countries in the report are Chad, with 1 in 11 women dying in pregnancy or childbirth, Afghanistan and Sierra Leone with one in eight, and Niger losing one in seven mothers.

"Americans tend to be complacent about pregnancy and childbirth. Most believe it is now more or less routine and no longer the deadly risk it was for their grandmothers. This is true for most U.S. women, but by no means for all," the U.N.-led group said in a statement.

The group includes U.N. agencies such as the World Health Organization and UNICEF, the World Bank and Family Care International.

According to the U.S. National center for Health Statistics, about 6 million U.S. women get pregnant every year. Four million children are born, about 1 million pregnancies end in miscarriages and another 1 million in induced abortion.

The major direct causes of U.S. pregnancy-related deaths are blood clots, hemorrhage, complications of medical conditions, and eclampsia and pre-eclampsia, which are marked by dangerously high blood pressure.

The death rate among U.S. black women was nearly four times the rate found among non-Hispanic white women -- 34.7 deaths per 100,000 live births for blacks versus 9.3 per 100,000 live births for whites, the report said.

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