“Maternal mortality” is a chilling phrase. And it’s a term that has haunted Georgia public health and medical officials for years.
Also known as death related to pregnancy, maternal mortality is defined as the death of a woman while she is pregnant or within one year after the end of her pregnancy, from any cause related to or aggravated by the pregnancy or its management.
A few years ago, a report surfaced that Georgia had the highest rate of maternal mortality in the nation. It came as jarring news.
The state was reported to have reached 28.7 maternal deaths per 100,000 live births in 2011, up from an average 20.2 in the period 2001 to 2006.
The Georgia General Assembly, alarmed by those numbers, passed a law last year that laid the foundation for a committee to review such deaths.
Recently the committee produced its first report, analyzing cases from 2012.
The panel determined that the original shocking statistics were not completely reliable. At the same time, the panel found some key trends in the Georgia deaths studied.
First the numbers: The maternal mortality panel leaders discovered that some Georgia deaths listed as related to or associated with pregnancy did not belong in those categories. The deaths had been wrongly classified.
“We found a lot of patients (who had died) had not been pregnant within a year,” Dr. Michael Lindsay, an Atlanta OB-GYN and chairman of the review panel, said recently.
The committee concluded there’s no way to say whether Georgia -- or some other state -- has the worst record on maternal mortality. Because of the uncertainty involved with available statistics, it’s impossible to compare states on maternal mortality.
“Only about 25 states do a formal maternal mortality review,” said Lindsay, associate professor in the division of gynecology and obstetrics at the Emory School of Medicine.
But the Peach State can’t take too much satisfaction in shedding that infamous No. 1 label. Lindsay said the panel also concluded that Georgia, in fact, has “among the highest rates” of maternal mortality.
BREAKING DOWN THE NUMBERS
The panel’s report identified 85 maternal deaths. Of those, 25 were classified as “pregnancy-related.” The other 60 occurred while the woman was pregnant or within one year of the end of the pregnancy, but were not necessarily related to the pregnancy. The panel called these deaths “pregnancy-associated.”
Other findings included:
Sixty percent of the maternal deaths were of women 29 or younger.
African-Americans were the predominant racial/ethnic group among the cases reviewed.
Obesity was a compounding factor in many cases.
The mortality report noted that chronic medical conditions increase risks during pregnancy. Pregnant or postpartum women often lack access to mental health services, and lack of access to care was cited as a potential problem.
The maternal mortality review effort came as a collaboration with the CDC, the Georgia Department of Public Health and the Georgia OBGyn Society.
Sen. Dean Burke, R-Bainbridge, a physician who sponsored legislation to create the state review panel, said last week that the obesity factor “surprised me the most -- how much influence it has on maternal mortality.”
Of the deaths from pregnancy-related reasons, the most common cause was hemorrhage, followed by cardiac disorders, embolism and seizure disorders. Among the deaths listed as pregnancy-associated, the leading causes were motor vehicle crashes, homicide and suicide.
“The results of our first year of work provided some excellent information on efforts that can be made in the medical community to decrease maternal deaths,” said Pat Cota, executive director of the Georgia OBGyn Society. “We have already begun education campaigns in a number of areas.”
“One of the key findings,” Cota added, “is that women need to be healthier before they become pregnant, through efforts such as weight management and hypertension control, so the pregnancy does not put undue stress on their bodies.”
Lindsay noted that the South generally has a higher rate of maternal mortality, and minorities account for a much higher percentages of these deaths than do whites.
MUCH MORE TO LEARN
The Georgia data are preliminary in terms of making recommendations, Lindsay cautioned.
“Our goal is to make the information widely available,” he said. “We need to recognize ... (maternal mortality) as a problem. It’s a matter of educating health care providers and the lay public that this is a public health problem.”
Burke, an ob/gyn who is now a Bainbridge hospital’s chief medical officer, pointed out that many hospitals in rural areas of Georgia have shut down their obstetrical services due to financial losses.
“We’ve got to stabilize that and stop the deterioration in the number of (obstetrics) units and providers,” he said.
Higher pay will help. The state budget, Burke noted, has increased reimbursements for OB-GYNs under the Medicaid program, which covers the majority of childbirths in the state.
Burke said he believes physicians will give a lot of consideration to the report’s findings.
“Doctors respond to data very well. It’s very critical that the committee continue to do the work it’s doing.”
The Department of Public Health, meanwhile, is collaborating with the Association of Women’s Health, Obstetric and Neonatal Nurses and Merck for Mothers to improve clinical practice and reduce errors related to postpartum hemorrhage, the leading cause of maternal death.
Public Health has joined other states to strengthen and enhance state maternal mortality surveillance systems. The agency has distributed maternal mortality education materials to OB-GYNs and hospitals throughout the state, along with information about the use of antidepressant medications in pregnancy.
Georgia birth certificates have been adjusted to reflect information about previous poor pregnancy outcomes and risk factors during the pregnancy being recorded, among other data. And the public health department is also reviewing changes to Georgia death certificates to more accurately identify maternal deaths.
The maternal mortality committee is already looking at possible pregnancy-related deaths from 2013.
“Our goal,” said Lindsay, “is to hopefully uncover information that will lead to lower mortality.”
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