Ensuring Accurate Completion of the Pregnancy Checkbox on Death Certificates

We need your help to ensure the accurate completion of the pregnancy checkbox on death certificates. Hospital-based providers and coroners play a critical role in ensuring the accurate completion of death certificates, especially regarding the pregnancy checkbox.

The Louisiana Pregnancy-Associated Mortality Review program reviews all pregnancy-associated deaths in the state to identify trends and opportunities for prevention. Pregnancy-associated deaths are identified first through Vital Records by using death certificates with the pregnancy checkbox. Through the pregnancy-associated death identification and verification process, discrepancies are identified when the pregnancy checkbox does not align with the pregnancy history identified in the patient’s clinical record. Between 2022 and 2023, the Louisiana Pregnancy-Associated Mortality Review team identified 113 errors in the pregnancy checkbox, with 27% occurring on death certificates signed by a certifying physician.

Accuracy of the pregnancy checkbox on death certificates is vital for producing reliable maternal mortality data. To ensure this accuracy, confirm the decedent’s pregnancy status by reviewing the medical and social history before making a selection for the pregnancy checkbox. The “Not Applicable” checkbox should never be selected for women of childbearing age, and while “Unknown” is an option, every effort should be made to determine the decedent’s true pregnancy status. Agencies such as the National Center for Health Statistics (NCHS) and the Pregnancy Mortality Surveillance System (PMSS) rely heavily on this information to generate national statistics on maternal deaths. These organizations track deaths that are related to pregnancy to monitor trends, identify disparities, and inform public health policies and interventions aimed at improving maternal health outcomes. When the pregnancy checkbox is marked incorrectly, it can result in misclassification of maternal deaths. This misclassification can result in inaccurate statistics that impact the ability to improve maternal healthcare, allocate resources appropriately, and evaluate the effectiveness of maternal health programs. Accurate maternal mortality data is crucial for shaping public health initiatives, guiding policy decisions, and reducing maternal mortality rates. Therefore, it is essential to complete death certificates with the highest level of accuracy.

We kindly ask for your cooperation in this process. Your diligence ensures that individuals receive accurate classification and contributes to improving maternal health outcomes at the state and national levels.

If you have any questions about this process, please contact the Pregnancy-Associated Mortality Review medical director, Dr. Veronica Gillispie-Bell, at Veronica.Gillispie@la.gov or the Pregnancy-Associated Mortality Review coordinator, Anjell DeGruy, at Anjell.DeGruy@la.gov.