Pregnancy-Related MortalityPregnancy-Related Mortalityin North Carolinain North Carolina

0

100

200

300

400

500

600

700

800

900

1000

Deaths per 100,000 live

births

1916 1920 1930 1940 1950 1960 1970

North Carolina

So, remind me, why are we still So, remind me, why are we still interested?interested?

Quality ImprovementQuality Improvement

Maternal mortality is considered an indicator of Maternal mortality is considered an indicator of the overall effectiveness of the obstetrical health the overall effectiveness of the obstetrical health care systemcare system

Potential for further preventionPotential for further prevention Many developed countries have a MMR less Many developed countries have a MMR less

than the USthan the US Discrepancies among various demographic Discrepancies among various demographic

groupsgroups The Healthy People 2010 goal of no more than The Healthy People 2010 goal of no more than

3.3 deaths per 100,000 live births3.3 deaths per 100,000 live births

ANDAND

0

5

10

15

20

25

30

Deaths per 100,000 live

births

1990 1993 1995 1997 1999 2001 2003 2005

North Carolina

Improvement through Improvement through PreventionPrevention

Prevention Prevention Requires an understanding of Requires an understanding of

Why women die of pregnancy-related Why women die of pregnancy-related complicationscomplications

How deaths could potentially be preventedHow deaths could potentially be prevented

North Carolina CDC ProjectNorth Carolina CDC Project

CommitteeCommitteeState-wide RepresentationState-wide Representation

AHEC RegionsAHEC Regions The 4 Medical Schools The 4 Medical Schools The State Dept of Health and Human The State Dept of Health and Human

ServicesServices CDCCDC

PreventabilityPreventability

All pregnancy-related deaths for 1995-All pregnancy-related deaths for 1995-1999 were reviewed for cause of death 1999 were reviewed for cause of death and potential for preventionand potential for prevention

Preventable: “”if the death may have been Preventable: “”if the death may have been averted by one or more changes in the averted by one or more changes in the health care system related to clinical care, health care system related to clinical care, facility infrastructure, public health facility infrastructure, public health infrastructure and/or patient factors.” infrastructure and/or patient factors.” 11

11((Mass Dept of Public HealthMass Dept of Public Health))

4 Areas 4 Areas

Preconception care and counselingPreconception care and counseling Patient actionsPatient actions System FactorsSystem Factors Quality of careQuality of care

ResultsResults

108 Pregnancy-related deaths108 Pregnancy-related deaths 105 with an identifiable cause105 with an identifiable cause 102 able to assess preventability102 able to assess preventability

40% preventable40% preventable

19.5%

34.1%

10.0%

53.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Preconc. Pt. Actions HC Syst Quality

Preventable

Cause of DeathCause of Death % of all preg-% of all preg-related deathsrelated deaths

% % PreventablePreventable

CardiomyopathyCardiomyopathy 2121 2222

HemorrhageHemorrhage 1414 9393

PIHPIH 1010 6060

CerebrovascularCerebrovascular 99 00

Chronic conditionChronic condition 99 8989

Amniotic fluid Amniotic fluid embolusembolus

77 00

Cause of DeathCause of Death % of all preg-% of all preg-related deathsrelated deaths

% % PreventablePreventable

InfectionInfection 77 4343

Pulmonary embolusPulmonary embolus 66 1717

Microangiopathic Microangiopathic hemolytic syndromeshemolytic syndromes

55 00

Cardiovascular Cardiovascular conditionsconditions

55 4040

ChoriocarcinomaChoriocarcinoma 44 2525

MiscellaneousMiscellaneous 33 3333

What have we done?What have we done?

Raise the level of awareness about PPCMRaise the level of awareness about PPCM Further study of PPCM in N.C.Further study of PPCM in N.C.

What do we need to doWhat do we need to do

Address quality of care: What can we do Address quality of care: What can we do about hemorrhage-related deathsabout hemorrhage-related deaths

Preconception CarePreconception Care Regionalization: referrals and transport for Regionalization: referrals and transport for

MATERNAL indications, not just neonatal MATERNAL indications, not just neonatal Continue surveillance and assessment of Continue surveillance and assessment of

preventabilitypreventability

Working Together to Reduce Working Together to Reduce Pregnancy-Related Mortality in NCPregnancy-Related Mortality in NC

Maternal Mortality Surveillance in Maternal Mortality Surveillance in N.C. N.C.

Annual basisAnnual basis Death certificates with pregnancy related Death certificates with pregnancy related

codes, ICD-9 630-676 or ICD-10 O00-codes, ICD-9 630-676 or ICD-10 O00-O099O099

Any written mention of pregnancy on the Any written mention of pregnancy on the DCDC

Linkage of all deaths of women ages 10-Linkage of all deaths of women ages 10-50 with the live birth and fetal death files 50 with the live birth and fetal death files for the same and previous calendar years for the same and previous calendar years

Maternal Mortality Surveillance in Maternal Mortality Surveillance in N.C.N.C.

Medical review processMedical review process Review of death and birth certificatesReview of death and birth certificates Autopsy reportsAutopsy reports Review of medical records if necessary and if Review of medical records if necessary and if

possiblepossible