2017 Louisiana Pregnancy-Associated Mortality Review Finds that Most Pregnancy-Associated Deaths Were Preventable

A majority of the 2017 deaths that occurred during pregnancy or within one year of pregnancy were preventable, the Louisiana Department of Health (LDH) reports in a newly released report on maternal mortality.

These findings come from the continuing work of the Louisiana Pregnancy-Associated Mortality Review (PAMR) committee, which reviews these deaths to identify causes and contributing factors and provide recommendations for prevention. Louisiana’s maternal death rate remains unacceptably high, especially among black mothers, and this report provides a wider view of the problem than in previous reports using an expanded methodology.

LDH’s review of maternal deaths occurring in 2011-2016, the first of its kind in Louisiana, reviewed only deaths that occurred during or within 42 days of pregnancy that were caused by a physiological condition related to the pregnancy. The new approach includes deaths due to any cause that occurred during pregnancy or within a year of childbirth (or miscarriage).

The expanded review process allows the PAMR committee to gain a more complete understanding of how and why maternal deaths occur in Louisiana, which leads to more comprehensive recommendations for how to prevent these deaths. The wider methodology reflected in the 2017 PAMR Report, however, means that findings from this report cannot be compared to those in the 2011-2016 Maternal Mortality Review report.

The 2017 PAMR report covers all pregnancy-associated deaths, a category which includes:

• Pregnancy-related deaths: The death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by the pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy (example cause of death: preeclampsia or eclampsia, i.e. uncontrolled and extreme high blood pressure during pregnancy leading to serious health complications, including possible organ damage).
• Pregnancy-associated, but not related deaths: The death of a woman during pregnancy or within one year of the end of pregnancy from a cause that is not related to pregnancy (example cause of death: car crash).
• Pregnancy-associated, but unable to determine relatedness deaths: A pregnancy-associated death where the cause of death is unable to be determined as “pregnancy-related” or “pregnancy-associated, but not related” (example cause of death: suicide).

Overall, 65 deaths were reviewed, and the committee found that most of them could have been prevented. The most common causes of deaths were homicide, cardiovascular and coronary conditions, motor vehicle crashes, and accidental overdose. Committee findings highlight the need to look beyond clinical causes of death and examine social factors (for example, multiple homicide cases illuminated a need to address intimate partner violence on a community level).

As LDH has found in previous analyses of maternal mortality and morbidity, there were significant racial disparities. Overall, black mothers in 2017 were twice as likely (2.2 times) to die as white mothers. These disparities were more pronounced among pregnancy-related deaths (deaths due to a physiologic condition related to the pregnancy). Over 5 black women (5.6) died for every 1 white woman among 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 on clinical practices that help prevent severe maternal morbidity and mortality. But there is more ground to cover, especially around racial disparities. This will require continued collaboration among hospitals and healthcare providers, community leaders and organizations, public health agencies, and policymakers.

Key recommendations from the report include:

• Improve care coordination before, during, and between pregnancies.
• Ensure pregnant women receive the appropriate level of care based on the complexity and severity of their medical issues and risk factors present.
• Expand the obstetric healthcare workforce to include cardiology, 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 (including hospitals, Emergency Medical Services, physician offices, and community clinics), as well as the institutions that influence or coordinate with that network (including public health agencies, Medicaid, and coroners).

The 2017 PAMR report was authored by members of the Office of Public Health and the Bureau of Family Health. Read the full report here.