A majority of the deaths in 2017 that occurred during a pregnancy or within one year of pregnancy were preventable, the Louisiana Department of Health is reporting in a newly released review of maternal deaths.
The findings highlight the continuing work of the Louisiana Pregnancy-Associated Mortality Review committee to identify the causes of maternal death in Louisiana and provide recommendations to prevent them. Louisiana’s maternal death rate remains unacceptably high, especially among black mothers and this report provides an expanded view of the problem through a major change in reporting.
The Department’s 2011-2016 review of maternal mortality, the first of its kind in Louisiana, reviewed only fatalities that occurred within 42 days of pregnancy and were a result of a condition related to the pregnancy. The new approach includes any deaths that occurred during pregnancy or within one year of childbirth.
The expanded review process, which will follow the same approach in future years, was made possible through key changes in how the Department reports deaths through Vital Records. The changes provide the Department and the public with much greater visibility into the causes of maternal death and what can be done to prevent them. This report’s wider methodology, however, means the results of the review of the maternal deaths cannot be compared to the results of the review of deaths from 2011 to 2016.
There are two key definitions that are used in the report:
- Pregnancy-associated deaths, which refers to a death that occurs during pregnancy or within one year of the end of the pregnancy, regardless of the cause. The definition includes women who died after or during a miscarriage or an ectopic pregnancy. This cause includes, but is not limited to, homicides and car accidents as well as deaths from coronary or cardiovascular conditions.
- Pregnancy-related deaths, which is limited to deaths caused by the physiologic effects of pregnancy, which could include, but is not limited to, high blood pressure or hemorrhage.
The review committee found that 80% of pregnancy-related deaths could have been prevented, and 90% of pregnancy-associated deaths were preventable. Overall, 65 total deaths were reviewed. There were 9 pregnancy-associated deaths that the PAMR committee was unable to determine if the death was due to a pregnancy-related condition. The top underlying cause of death within this category was suicide.
The most common causes of deaths were homicide, cardiovascular and coronary conditions, motor vehicle crashes and accidental overdose. In the Department’s expanded review, there are new findings that highlight the need to look beyond clinical causes of death and examine social factors – especially homicides that are connected to intimate partner violence.
As the Department has found in previous reviews of maternal mortality and maternal morbidity, there were significant racial disparities among the women who experienced a maternal mortality. The disparities were especially glaring in the review of pregnancy-related deaths, or deaths that were related to a physiologic condition related to the pregnancy.
Overall, Black mothers in 2017 were twice as likely (2.2 times) to die as white women, and far more likely to die of a pregnancy-related issue. Among pregnancy-related deaths, over 5 Black women (5.6) died for every 1 white woman in pregnancy-related deaths in 2017.
The report finds that there is more work to do around comprehensive prevention. The Louisiana Perinatal Quality Collaborative, which launched in August 2018, has made great strides in working with hospitals and birthing centers around clinical practices that aim to prevent severe maternal morbidity and mortality. But there is more ground to cover, especially around racial disparities. This will require continued collaboration among hospitals, community organizations and policy-makers.
Key recommendations in the report include:
- Improve care coordination before, during and between pregnancies, especially with a focus on the complexity and severity of medical issues and risk factors for individuals.
- Expand the obstetric healthcare workforce to include a variety of providers, to include cardiologists, psychiatric and addiction specialists.
- Improve and expand identification of and treatment for substance use during pregnancy.
- Address racial and cultural bias across the network of care that serves pregnant and postpartum women.