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Maternal Mortality in Georgia Through the Public Health Lens
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Transcript of Maternal Mortality in Georgia Through the Public Health Lens
Maternal Mortality in Georgia: Through the Public Health Lens
Presenter: Maria Fernandez
Healthy Mothers, Healthy Babies Annual Meeting
Oct 7, 2014
IN 2013
85 WOMEN DIED
MATERNAL MORTALITY
G E O R G I A RA N K S
# 50
N A T I O N A L LY
AWHONN 2013
Overview
Inform Protect Prevent
COLLECTIVE IMPACT
Evolution of Maternal Mortality Definition
1975 1980 1985 1990 1995 2000 2005 2010
2003-present5 supplemental fields added to death certificate to determine death timing in relation to pregnancy.
1992Other states add separate pregnancy question to track time of death.
1900-1979: ICDDeath of a pregnant woman or recently pregnant woman as a result of complications of pregnancy or childbirth.
1979: ICD ExpansionExplicit ICD codes broadened. Parameters added to focus on time of death within 42 days post-partum.
1999-2003ICD-10 change include direct obstetric deaths, indirect obstetric deaths, late maternal death and pregnancy-related death. Results in CDC DRH, NVSS and ICD using different terms for similar concepts.
INFORM:
Epidemiology of Maternal Mortality
Worldwide Maternal Mortality: 2013
Worldwide Maternal Mortality: 1990-2013
North & South America
North & South America
United States Maternal Mortality: 1987-2010
Maternal Mortality: United States
50,000suffer severe morbiditiesdue to pregnancy-related complications
For women in the United States, each year:
650die
due to p regnancy-
re la ted compl i ca t ions
This means that for every 1 woman who dies due to a pregnancy-related condition, another 76 women experience a severe co-morbidity. 70%
in20
years
Georgia Maternal Mortality Rate 2002-2012
Source: Georgia Vital Statistics
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
10
20
30
40
50
60
70
Rati
o (
Per
1,0
00
) live b
irth
s
Georgia Maternal Mortality Initiatives
Georgia Maternal Mortality Initiatives
Partnership with Emory University
Medicaid Policy Changes
Maternal Mortality Review Committee
1
2
3
Working with Emory to expand midwifery training programs
• P4HB to increase family planning• Payment for LARCs at delivery
Partnership with the Georgia OB/Gyn Society to lead the MMRC
Georgia Maternal Mortality Review Committee
MMRC Members
Chair- Dr. Michael Lindsay
Clinicians
Public Health
Practitioners
Mental Health
Providers
Coordinator: Debbie
Sibley
Chart Abstractors
Sub Committee
Purpose of the MMRC
• Identify all maternal deaths in Georgia• Review maternal deaths that are/may be
pregnancy-related• Determine modifiable factors related to
the death• Develop non-punitive actionable
recommendations• Reduce maternal death
Case review criteria
Maternal Death• Death must have occurred to a woman
who was either pregnant at time of death or within one year
Pregnancy-Related Maternal Death• Suicides and drug overdoses within six
months • Motor vehicle accidents within six months• Intentional and unintentional injuries not
routinely reviewed
Maternal Death
Pregnancy Associated Mortality
Pregnancy Related
Mortality
Maternal death identification process
Deaths Identified
Check Mark Death Certificate
Mandatory Reporting
Vital Records Linkage
DeathSelect cases for
abstractionCommittee recommend-
ations
MMRC Process
Limitations on identification process
Identification of maternal deaths are complicated
• What happens if a mom was a resident of a different state at delivery?
• Do you capture deaths related to induced terminations?
Death certificates are not always complete and/or accurate
Fetal death certificates are not routinely completed
Findings from MMRC
Georgia 2012 Maternal Mortality
Maternal Mortality, Georgia 2012
Pregnancy-Associated Pregnancy-Related
N = 61
N = 24
85total
Maternal mortality by timing of death Georgia, 2012
Whi
le P
regn
ant
1-42
day
s po
st-p
artu
m
43-3
65 d
ays
post
-par
tum
0
10
20
30
40
50
60
17 16
52
8 5
48
9 114 Total
Pregnancy-AssociatedPregnancy-RelatedF
req
uen
cy
Maternal mortality by race Georgia, 2012
Fre
qu
en
cy
White Black Hispanic Other0
5
10
15
20
25
30
35
40
45
Pregnancy Associated
Pregnancy Related
Total
Maternal mortality by age Georgia, 2012
Fre
qu
en
cy
Less than 20 yrs old
20-24 yrs old
25-29 yrs old
30-34 yrs old
35+ yrs old0
5
10
15
20
25
30
TotalPregnancy Asso-ciatedPregnancy Related
Maternal mortality by education Georgia, 2012
Less
than
12
year
sHS
Som
e Co
llege
Colle
ge
Colle
ge+
0
5
10
15
20
25
30
Pregnancy Associated
Pregnancy Related
Total
Fre
qu
en
cy
Maternal mortality by marital status Georgia and payor, 2012
Married Single 0
10
20
30
40
50
60
22
37
10
14
Pregnancy-AssociatedPregnancy-RelatedSeries3
Medicaid Private Self pay Other0
5
10
15
20
25
30
35
40
45
50
31
51
13
13
2
0
0
Pregnancy-AssociatedPregnancy-RelatedSeries3
Maternal mortality by occupation: Georgia, 2012
35
2
10
17
35
15
26
20
0
5
9
4 1
0
1
1
1
Chart Title
Pregnancy-Associated
Pregnancy-Related
Maternal mortality by mode of delivery: Georgia, 2012
N=68
Vaginal Cesarean0
5
10
15
20
25
30
35
40
27
37
22
26
5
11
TotalPregnancy AssociatedPregnancy Related
Leading Causes of Maternal Mortality
Maternal mortality by cause of death:
Worldwide
Hemorrhage Infection Eclampsia Obstructed Labor
Unsafe Abortion
0
5
10
15
20
25
30
25%
15%
13%
7%
13%
Perc
enta
ge o
f all p
regnancy
-rela
ted
death
s
Maternal mortality by cause of death:
United States
Cardi
ovas
cula
r di
seas
e
Infe
ctio
n
Non-c
ardi
ovas
cula
r di
seas
e
Cardi
omyo
path
y
Hemor
rhag
e
Thro
mbo
tic p
ulm
onar
y em
bolis
m
Hyper
tens
ive
diso
rder
of p
regn
ancy
cere
brov
ascu
lar ac
cide
nt
amni
otic fl
uid
embo
lism
anes
tesia
com
plicat
ions
0
2
4
6
8
10
12
14
1615%
14%13%
12% 12%
10% 9%
6%5%
1%
Perc
ent
of
all p
regnancy-r
ela
ted d
eath
s
Maternal mortality by cause of death: Georgia
Cardiac Embolism Seizure disorder Hemorrhage Hypertension Drug overdose0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
21%
17%
13%
8% 8% 8%
Perc
ent
of
all p
regnancy r
ela
ted d
eath
s
An In-Depth Review of Initially Identified Cases
Chronic Diseases Apparent During the Prenatal Period, Georgia 2012
N = 34
Depression Diabetes Epilepsy Hypertension Sickle Cell Other0
2
4
6
8
10
12
5
4
6
10
2
11
Maternal Mortality by pre-pregnancy weight: Georgia 2012
(N=17)
Normal Overweight Obese Morbidly Obese0
1
2
3
4
5
6
7
TotalPregnancy AssociatedPregnancy Related
Georgia Maternal Mortality Health Promotion Initiatives
Chronic Disease & Pregnancy Awareness
http://youtu.be/K02elLJotaU
Cardiac Brochure
Chronic Disease Poster
SCD Brochure
Diabetes Brochure
Georgia Maternal Mortality Gap
October: Domestic Violence Month
Prevent
Prevention Strategies
• Expansion of midwives• Increase family planning• Risk screening through prenatal care
• Early detection of problems can lead to better preparation at birth
• If no risks are found could provide a false sense of security
MMRC current action item
AMCHP Grant• Every Mother’s Initiative grant ($30,000: 1
year)
Focused on risk factors• Chronic diseases
Two arms• Provider education• Patient education
Protect
Maternal Mortality Law
SB 273 – Senator Burke• Requires public health to establish a
maternal mortality review committee• Provide legislative findings • Provide data• Provide confidentiality and limited
liability of reviews
Collective Impact
Collective Impact
• The risk factors associated with whether a woman lives or dies as a result of pregnancy are the same risk factors that are associated with if a baby lives or dies.
• Understand and address the role of social determinants on maternal death• Housing?• Education?• Finances?
How you can help?
Providers:• Report maternal deaths• Join our perinatal quality collaborative• Every woman, every time
Public:• Encourage healthy behaviors and lifestyles• Encourage early and regular prenatal care• End domestic violence• Address mental health concerns• Advocate for paid maternity leave
Food for thought
• What role does the father play in preventing maternal death?
• Social support decreases infant death, what about maternal death?
• What about the mom after the baby is born? – Program support is usually focused on baby– Family support is usually focused on baby
• How can we better focus on women who were recently pregnant, and not just mothers?
Pregnancy is SPECIAL, Let’s make it SAFE
~Safe Motherhood