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Lessons Learned from Maternal Mortality Review, Montana, 2003-2009

Lessons Learned from Maternal Mortality Review, Montana, 2003-2009. Dorota Carpenedo, MPH Maternal and Child Health Epidemiologist, Office of Epidemiology and Scientific Support, Montana Department of Public Health and Human Services. . Outline.

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Lessons Learned from Maternal Mortality Review, Montana, 2003-2009

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  1. Lessons Learned from Maternal Mortality Review, Montana, 2003-2009 • Dorota Carpenedo, MPH • Maternal and Child Health Epidemiologist, • Office of Epidemiology and Scientific Support, • Montana Department of Public Health and Human Services.

  2. Outline Part 1: Ascertainment of Maternal Deaths - Definitions - Certifying or Reporting a Maternal Death- Findings Part 2: How MT Hospitals Review Maternal Deaths - Survey of Hospital Maternal Mortality Review ProcessPart 3: Summary

  3. What triggered this project ? Pregnant Woman and Death - By: Egon Schiele, 1911

  4. Part 1.Ascertainment of Maternal Deaths

  5. Which Deaths? • Definitions: • ICD-10 • NCHS • ACOG/CDC Maternal Mortality Study Group

  6. 1. ICD-10 Definitions Maternal Death: - Pregnant or within 42 days of pregnancy - Related to or aggravated by pregnancy • Late Maternal Death • Within 43 to 365 days after • pregnancy • Related to or aggravated • by pregnancy • Pregnancy-related • Pregnant or within 42 days after • pregnancy • May or may not be caused by • pregnancy • May include trauma

  7. 2. NCHS Definitions • Apply to ICD-10 Maternal or Late Maternal Death • Direct obstetric • Labor • Indirect obstetric • Aggravated by physiologic • effects of pregnancy

  8. 3. ACOG/CDC Definitions Considering ICD-10 and NCHS, broadest definitions • Pregnancy-related • Pregnant or within 1 year • of pregnancy • - Related to pregnancy • Pregnancy-associated • Pregnant or within 1 year • of pregnancy • - Regardless of cause MT DPHHS Def.

  9. Certifying or Reporting a Maternal Death

  10. CertifyingMaternal Death • Legal process • Certifier’s responsibility • - Fill out death certificate completely • - Include pregnancy status • Determines cause(s) of death • - cause and manner

  11. Death Certificate • Pregnancy checkbox since 2003 • Source: http://www.cdc.gov/nchs/data/dvs/death11-03final-acc.pdf

  12. Maternal Death Ascertainmentin MT Office of Vital Statistics • Data Linkage  Women’s death certificates matched: - Birth certificates - Fetal death certificates

  13. Maternal Mortality Ratio (MMR): # maternal deaths/100,000 live births during pregnancy or within 1 year of termination. MT MMR 10-year average (2000-2009) = 13.7/100,000 live births

  14. Findings

  15. ICD-10 and NCHS • Not associated with obstetric codes • Found with check box or linkage

  16. Part 2. How MT Hospitals Review Maternal Deaths

  17. Survey of Montana Hospitals, 2011 • Maternal deaths • - Review - Ascertainment - Definition • 83% (49 of 59 surveys returned)

  18. * Check all that apply Hospital setting

  19. Part 3.Summary

  20. There is NO Formal Maternal Mortality Review by Montana Department of Public Health and Human Services

  21. Public Health Message: • Report deaths you know about to DPHHS • - Name and date are sufficient • DPHHS not authorized to receive medical chart data • Broadest ACOG/CDC definition - Pregnancy-associated deaths

  22. Public Health Message Cont.: • Fact and cause of death are public • Encourage hospitals to report to DPHHS • Be working group advisors

  23. MT DPHHS Interest Not: - Disciplinary - Legal • Yes: • - Are deaths preventable? • - What public health measures could help?

  24. Example • Eclampsia  seizures/comma  death • DPHHS is not concerned with medical management • DPHHS is concerned with “early and frequent • prenatal care tomonitor blood pressure in pregnancy”

  25. MT DPHHS Activities • Current - Data base • Proposed - Linkage to Medicaid - Linkage to Dept Transportation FARS - Secure electronic reporting system

  26. DPHHS Near Future Activities • 1. Analyses based on death certificates • 2. Raise awareness of pregnancy-associated mortality - Public health focus • 18 deaths so far 2010 – 2011 - 4 or 5 suicides - 6 vehicle crashes - Prepare for possible legislation for formal Review Committee

  27. MT DPHHS Long-Term Goal • Statewide Maternal Mortality Review • Modeled on Fetal, Infant, and Child Mortality • Review (FICMR) • Collaboration - state / local public health agencies - many professions (hospital administrators, policy makers, etc.)

  28. Thank you In memory of all the women who died during pregnancy, childbirth and within the year of giving birth.

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