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Examination of a death due to cardiomyopathy by a maternal mortality review committee.

Abstract：

:Deaths related to pregnancy were relatively common in the United States at the beginning of the twentieth century. A dramatic reduction of 99% in maternal mortality rate, from 850.0-7.5 per 100,000 live births from 1900-1982, is 1 of the most noteworthy public health success stories of the time period. This plateau continued until the late 1990s when the maternal mortality rate began to rise again. The reasons for this increase are unclear. Vital statistics data alone cannot answer the many questions surrounding this increase. The need for detailed and reliable information about causes of death and underlying factors has led to the development of state- and urban-based maternal death reviews. Although processes may vary, an expert panel is convened to review individual cases and make recommendations for systems change. Review of maternal deaths is considered to be a core public health function. There are multiple purposes for this article. The first goal is to highlight the components of a maternal mortality review. The second goal is to provide an example for new review committees. A mock case of cardiomyopathy is used to illustrate both the process and development of actionable recommendations for clinical intervention. Recommendations to address community- and system-level contributing factors and the social determinants of health are discussed. The third goal is to educate providers regarding presentation and management of cardiomyopathy. Fourth, it is hoped that policymakers in the area of maternal health and facilities that review maternal morbidity and mortality rates at the institutional level will find the article useful as well. Finally, the article provides facility-level committees with a process example for review of the circumstances of maternal deaths beyond clinical factors so that they may make recommendations to address nonclinical contributors to pregnancy-related deaths. Documenting both clinical and nonclinical contributors to maternal death are critical to influence public opinion, develop coalitions for collective impact, and engage at risk populations in proposing interventions.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Shellhaas CS,Zaharatos J,Clayton L,Hameed AB

doi

10.1016/j.ajog.2019.01.211

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

1-8

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(19)30241-8

journal_volume

221

pub_type

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Examination of a death due to cardiomyopathy by a maternal mortality review committee.