Skip to main content

Advertisement

SpringerLink
Log in

Pregnancy-Related Deaths, Florida, 1999–2012: Opportunities to Improve Maternal Outcomes

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Objectives To examine pregnancy-related deaths (PRDs) in Florida, to identify quality improvement (QI) opportunities, and to recommend strategies aimed at reducing maternal mortality. Methods The Florida Pregnancy-Associated Mortality Review (PAMR) Committee reviewed PRDs occurring between 1999 and 2012. The PAMR Committee determined causes of PRDs, identified contributing factors, and generated recommendations for prevention and quality improvement. Information from the PAMR data registry, and live births from Florida vital statistic data were used to calculate pregnancy-related mortality ratios (PRMR) and PRD univariate risk ratios (RR) with 95% confidence intervals (CI). Results Between 1999 and 2012, the PRMR fluctuated between 14.7 and 26.2 PRDs per 100,000 live births. The five leading causes of PRD were hypertensive disorders (15.5%), hemorrhage (15.2%), infection (12.7%), cardiomyopathy (11.1%), and thrombotic embolism (10.2%), which accounted for 65% of PRDs. Principal contributing factors were morbid obesity (RR = 7.0, 95% CI 4.9–10.0) and late/no prenatal care (RR = 4.2, 95% CI 3.1–5.6). The PRMR for black women was three-fold higher (RR = 3.3, 95% CI 2.7–4.0) than white women. Among the five leading causes of PRDs, 42.5% had at least one clinical care or health care system QI opportunity. Two-third of these were associated with clinical quality of care, which included standards of care, coordination, collaboration, and communication. The QI opportunities varied by PRD cause, but not by race/ethnicity. Conclusion Gaps in clinical care or health care systems were assessed as the primary factors in over 40% of PRDs leading the PAMR Committee to generate QI recommendations for clinical care and health care systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Amnesty International. (2010). Deadly delivery: The maternal health care crisis in the USA. London (UK): Amnesty International Secretariat. http://www.amnestyusa.org/research/reports/deadly-delivery-the-maternal-health-care-crisis-in-the-usa. Accessed 29 July 2015.

  • Berg, C. J., Callaghan, W. M., Syverson, C., & Henderson, Z. (2010). Pregnancy-related mortality in the United States, 1998 to 2005. Obstetrics and gynecology, 116(6), 1302–1309.

    Article  PubMed  Google Scholar 

  • Berg, C. J., Harper, M. A., Atkinson, S. M., Bell, E. A., Brown, H. L., Hage, M. L., et al. (2005). Preventability of pregnancy-related deaths: Results of a state-wide review. Obstetrics and Gynecology, 106(6), 1228–1234.

    Article  PubMed  Google Scholar 

  • Bodker, B., Hvidman, L., Weber, T., Møller, M., Aarre, A., Nielsen, K. M., et al. (2009). Maternal death in Denmark 2002–2006. Acta Obstetrics and Gynecology, 88, 556–562.

    Article  Google Scholar 

  • Burch, D., Noell, D., Hill, W. C., & Delke, I. (2012). Pregnancy-associated mortality review: The Florida experience. Seminars in Perinatology. 36, 31–36.

    Article  PubMed  Google Scholar 

  • Callaghan, W. M., & Berg, C. J. (2003). Pregnancy-related mortality among women aged 35 years and older, United States, 1991–1997. Obstetrics and Gynecology, 102(5 Pt), 1015–1021.

    PubMed  Google Scholar 

  • Callaghan, W. M., Kuklina, E. V., & Berg, C. J. (2010) Trends in postpartum hemorrhage: United States, 1994–2006. American Journal of Obstetrics and Gynecology, 202353, e1-353.e6. https://doi.org/10.1016/j.ajog.2010.01.011.

    Google Scholar 

  • Campbell, K. H., Savitz, D., & Werner, E. F. (2013). Maternal morbidity and risk of death at delivery hospitalization. Obstetrics and Gynecology, 122(3), 627–633.

    Article  PubMed  Google Scholar 

  • Cantwell, R., Clutton-Brock, T., Cooper, G., Dawson, A., Drife, J., Garrod, D., et al. (2011). Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006-08. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG: An International J Obstet Gynaecol, 118(Suppl. 1), 1–203. https://doi.org/10.1111/j.1471-0528.2010.02847.x.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2011). Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)—United States, April 2009–August 2010. MMWR. Morbidity and Mortality Weekly Report, 60(35), 1193–1196.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2012). Ectopic pregnancy mortality—Florida, 2009–2010. MMWR. Morbidity and Mortality Weekly Report. 61(6), 106–109.

    Google Scholar 

  • Clark, S. L., Christmas, J. T., Frye, D. R., Meyers, J. A., & Perlin, J. B. (2014). Maternal mortality in the United States: Predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage. American Journal of Obstetrics and Gynecology, 211, 32 e1-9. https://doi.org/10.1016/j.ajog.2014.03.031.

    Article  PubMed  Google Scholar 

  • Creanga, A. A., Berg, C. J., Ko, J. Y., Farr, S. L., Tong, V. T., Bruce, F. C., et al. (2014). Maternal mortality and morbidity in the United States: Where are we now? Journal of Women’s Health, 23(1), 3–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, C., & Callaghan, W. M. (2012). Race, ethnicity and nativity differentials in pregnancy-related mortality in the United States: 1993–2006. Obstetrics and Gynecology, 120(2), 261–268.

    Article  PubMed  Google Scholar 

  • Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2015). Pregnancy-related mortality in the United States, 2006–2010. Obstetrics and Gynecology, 125(1), 5–12.

    Article  PubMed  Google Scholar 

  • Creanga, A. A., Shapiro-Mendoza, C. K., Bish, C. L., Zane, S., Berg, C. J., & Callaghan, W. M. (2011). Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstetrics and Gynecology, 117(4), 837–843.

    Article  PubMed  Google Scholar 

  • D’Alton, M. E., Bonanno, C. A., Berkowitz, R. L., Brown, H. L., Copel, J. A., Cunningham, F. G., et al. (2013). Putting the “M” back in maternal-fetal medicine. American Journal of Obstetrics & Gynecology, 208(6), 442–448.

    Article  Google Scholar 

  • Dean, A., Sullivan, K., Soe, M., & OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2.3.1. http://www.OpenEpi.com updated 2015/05/04, Accessed 24 October 2015.

  • Deneux-Tharaux, C., Carmona, E., Bouvier-Colle, M. H., & Bréart, G. (2006). Postpartum maternal mortality and cesarean delivery. Obstetrics and Gynecology, 108(3 Pt), 541–548.

    Article  PubMed  Google Scholar 

  • Florida Department of Health (FDOH), CHARTS. http://www.floridacharts.com/charts/SearchResult.aspx.

  • Florida Department of Health (FDOH), PAMR. http://www.floridahealth.gov/statistics-and-data/PAMR/.

  • Florida’s perinatal quality collaborative (FPQC). http://health.usf.edu/publichealth/chiles/fpqc/index.htm.

  • Geller, S. E., Koch, A. R., Martin, N. J., Rosenberg, D., & Bigger, H. R. (2014). Assessing preventability of maternal mortality in Illinois: 2002–2012. American Journal of Obstetrics and Gynecology, 211(6), 698. https://doi.org/10.1016/j.ajog.2014.06.046.

    Article  PubMed  Google Scholar 

  • Hankins, G. D., Clark, S. L., Pacheco, L. D., O’Keeffe, D., D’Alton, M., & Saade, G. R. (2012). Maternal mortality, near misses, and severe morbidity: Lowering rates through designated levels of maternity care. Obstetrics and Gynecology, 120(4), 929–934.

    Article  PubMed  Google Scholar 

  • Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., et al. (2014). Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 980–1004.

    Article  PubMed  PubMed Central  Google Scholar 

  • Main, E. K., McCain, C. L., Morton, C. H., Holtby, S., & Lawton, E. S. (2015). Pregnancy-related mortality in California: Causes, characteristics, and improvement opportunities. Obstetrics and Gynecology, 125(4), 938–947.

    Article  PubMed  Google Scholar 

  • New Jersey Maternal Mortality Review. Trends in Statewide Maternal Mortality, New Jersey 2009–2013. http://www.state.nj.us/health/fhs/professional/mortality.shtml.

  • The Joint Commission. (2010). Sentinel event alert: Preventing maternal death. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_44.htm. Accessed 23 October 2015.

Download references

Acknowledgements

Special thanks to the Florida Pregnancy Associated Mortality Review (PAMR) Committee Members; Danielle Noell ARNP, MSN and the PAMR Abstractors; Angel Watson MPH, RHIA; Charles Mahan, MD; Annette Phelps ARNP, MSN; Rhonda Brown, R.N., B.S.N. Additional thanks to Kris-Tena Albers, ARNP, CNM; Keshia Reid, PhD, Carol Scoggins, MS; and Dan Thompson, MPH for their assistance in reviewing this manuscript. Florida’s PAMR project is supported through the Maternal and Child Health Block Grant (Title V).

Author information

Authors and Affiliations

  1. Maternal and Child Health Section, Division of Community Health Promotion, Florida Department of Health, 4052 Bald Cypress Way, Bin #A13, Tallahassee, FL, 32399-1725, USA

    Leticia E. Hernandez & Deborah Burch

  2. The Chiles Center, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC56, Tampa, FL, 33612-3805, USA

    William M. Sappenfield

  3. American College of Obstetricians and Gynecologist District XII Florida, 6440 W. Newberry Road, Suite 508, Gainesville, FL, 32605, USA

    Karen Harris

  4. Florida Department of Health, 8304 Alexandria Court, Sarasota, FL, 34238, USA

    Washington C. Hill

  5. Association of Maternal and Child Health Programs, 1825 K Street, NW, Suite 250, Washington, DC, 20006, USA

    Cheryl L. Clark

  6. College of Medicine, Obstetrics & Gynecology, University of Florida, 653-1 West 8th Street, LRC 3rd Floor, Jacksonville, FL, 32209-6511, USA

    Isaac Delke

Authors
  1. Leticia E. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William M. Sappenfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karen Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deborah Burch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Washington C. Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cheryl L. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Isaac Delke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leticia E. Hernandez.

Ethics declarations

Financial Disclosure

The authors do not report any potential conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hernandez, L.E., Sappenfield, W.M., Harris, K. et al. Pregnancy-Related Deaths, Florida, 1999–2012: Opportunities to Improve Maternal Outcomes. Matern Child Health J 22, 204–215 (2018). https://doi.org/10.1007/s10995-017-2392-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-017-2392-y

Keywords

Search

Navigation