1. Pregnancy-Related Mortality in North Carolina

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

4. Quality Improvement

5.  Maternal mortality is considered an indicator of the overall effectiveness of the obstetrical health care system  Potential for further prevention  Many developed countries have a MMR less than the US  Discrepancies among various demographic groups  The Healthy People 2010 goal of no more than 3.3 deaths per 100,000 live births

6. AND

8. Improvement through Prevention

9. Prevention Requires an understanding of  Why women die of pregnancy-related complications  How deaths could potentially be prevented

10. North Carolina CDC Project

11. Committee State-wide Representation  AHEC Regions  The 4 Medical Schools  The State Dept of Health and Human Services  CDC

12. Preventability  All pregnancy-related deaths for 1995- 1999 were reviewed for cause of death and potential for prevention  Preventable: “”if the death may have been averted by one or more changes in the health care system related to clinical care, facility infrastructure, public health infrastructure and/or patient factors.” 1 1 ( Mass Dept of Public Health )

13. 4 Areas  Preconception care and counseling  Patient actions  System Factors  Quality of care

14. Results  108 Pregnancy-related deaths  105 with an identifiable cause  102 able to assess preventability

15. 40% preventable

17. Cause of Death % of all preg- related deaths % Preventable Cardiomyopathy2122 Hemorrhage1493 PIH1060 Cerebrovascular90 Chronic condition 989 Amniotic fluid embolus 70

18. Cause of Death % of all preg- related deaths % Preventable Infection743 Pulmonary embolus 617 Microangiopathic hemolytic syndromes 50 Cardiovascular conditions 540 Choriocarcinoma425 Miscellaneous333

19. What have we done?  Raise the level of awareness about PPCM  Further study of PPCM in N.C.

20. What do we need to do  Address quality of care: What can we do about hemorrhage-related deaths  Preconception Care  Regionalization: referrals and transport for MATERNAL indications, not just neonatal  Continue surveillance and assessment of preventability

21. Working Together to Reduce Pregnancy-Related Mortality in NC

23. Maternal Mortality Surveillance in N.C.  Annual basis  Death certificates with pregnancy related codes, ICD-9 630-676 or ICD-10 O00- O099  Any written mention of pregnancy on the DC  Linkage of all deaths of women ages 10- 50 with the live birth and fetal death files for the same and previous calendar years

24. Maternal Mortality Surveillance in N.C.  Medical review process Review of death and birth certificates Review of death and birth certificates Autopsy reports Autopsy reports Review of medical records if necessary and if possible Review of medical records if necessary and if possible