Characteristics of Pregnancy-Related Deaths Due to Hemorrhage, 2017-2019 公开
Harvey, Alyssa (Spring 2023)
Abstract
Background: Hemorrhage is a leading underlying cause of pregnancy-related death, and in a recent analysis of 1,018 pregnancy-related deaths from Maternal Mortality Review Committees (MMRCs) in 36 U.S. states, it accounted for 13.7% of pregnancy-related deaths. Postpartum hemorrhage, ectopic pregnancy, and placenta accreta spectrum have all been identified as important contributors to hemorrhage and pregnancy-related mortality. MMRCs are uniquely situated to identify contributing factors of pregnancy-related deaths due to hemorrhage as well as the context in which these deaths occurred.
Methods: This analysis examined a subset of aggregate Maternal Mortality Review Information Application (MMRIA) dataset of pregnancy-related deaths occurring from 2017-2019. Data was further restricted to preventable, pregnancy-related deaths due to hemorrhage when examining contributing factor classes, contributing factor levels, and recommendation levels, which are unique to deaths deemed preventable. All categorical variables were summarized quantitatively using percentages. Among the preventable pregnancy-related deaths with an underlying specific cause of ectopic rupture, a mixed inductive and deductive thematic analysis was performed on the committee-assigned contributing factors and recommendation free-text fields.
Results: There were 133 total pregnancy-related with an underlying cause of death of hemorrhage. Ruptured ectopic pregnancy accounted for 21.1% of cases. 90.1% of the 133 deaths were determined to be preventable. The most common contributing factor classes among the patient/family and provider levels was knowledge while clinical skill/quality of care was the most common class among the facility, systems, and community levels. Barriers to care, delay in identification, treatment, and transfer of care, clinical skill and quality of care (including assessment, continuity of care/care coordination, and policies/procedures), awareness, knowledge, and education, as well as reproductive health were identified as key findings from the thematic analysis.
Conclusion: The results of this analysis can be used to inform a variety of clinical, social, and epidemiological programs and research activities. While descriptive in nature, these results can be used to inform future association studies such as case-control and cohort studies. The qualitative findings can help guide prevention and clinical interventions geared toward pregnancy-related deaths due to ectopic rupture.
Table of Contents
Table of Contents
Background. 1
Hemorrhage as a Leading Cause of Maternal Mortality. 1
Racial and Ethnic Disparities. 2
Etiologies of Pregnancy-Related Mortality with an Underlying Cause of Hemorrhage. 2
Preventability of Pregnancy-Related Deaths. 3
Research Gaps and Purpose of this Analysis. 4
Methods. 6
Population and Data Source. 6
Characterizing Pregnancy-Related Deaths with an Underlying Cause of Hemorrhage. 7
Preventable Pregnancy-Related Deaths with an Underlying Cause of Hemorrhage. 10
Qualitative Analysis of Contributing Factors Descriptions and Recommendations for Preventable, Ectopic Ruptures. 11
Results. 12
Quantitative Results. 12
Thematic Analysis of Contributing Factors and Recommendations. 13
Barriers to Care. 13
Delay in Identification, Treatment, and Transfer of Care. 14
Clinical Skill & Quality of Care. 14
Awareness, Knowledge, & Education. 16
Reproductive Health Services. 17
Discussion. 23
References: 27
About this Master's Thesis
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