Download Maternal Mortality Ratios - Washington State Hospital Association

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Maternal Mortality
International
United States
Washington State
Thomas R. Easterling, MD
Professor
Maternal-Fetal Medicine
University of Washington
Seattle, WA
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Georgia
Afghanistan
Ivory Coast
Nigeria
Cameroon
Georgia
Namibia
Botswana
South Africa
Swaziland
Zimbabwe
Mozambique
Malawi
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Hemorrhage
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Columbia
MMR 76
≥30%
Mexico
MMR 57
20-30%
India
MMR 323
≤ 10%
Hypertension
Chile
MMR 41
20-30%
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Africa
Asia
Hemorrhage
Africa - South Asia
Hemorrhage
Hypertension
Hypertension
Embolism
Embolism
Latin America-Caribbean Developed Countries
Hemorrhage
Hemorrhage
Abortion
Hypertension
Hypertension
• MMR 300-600/100,000
• 9% Hypertension
Latin America - Caribbean
• MMR 50-100/100,000
• 25% Hypertension
Canada
• MMR 6.1/100,000
• 14% Hypertension
Netherlands
Embolism
• MMR 8.8/100,000
• 39% Hypertension
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Delay in Diagnosis
• Asymptomatic until severe
• Technology required
• Skilled operator
Delay Reaching Care
• Roads
• Access to vehicles
• Social customs
Delay Appropriate Care
• MgSO4
• Blood pressure control
• Delivery
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Treatment of Preeclampsia
Low Resource Settings
Nagpur
Lucknow
Vellore
Deliveries
MMR
Booked
Eclampsia Rate
Case-Fatality Rate
Lucknow
4652
3.2%
5.4%
14.7%
Nagpur
9600
319
65%
2.6%
8.1%*
Vellore
8702
376
100%
0.6%
6.1%
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Eclampsia Rate /10,000 births
High-income Countries
>10X
reduction
Low-income Countries
minimal
reduction
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Eclampsia Case Fatality Rate (%)
High-income Countries
>10X
reduction
Low-income Countries
minimal
reduction
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Perinatal Advisory Committee
Maternal Mortality Subcommittee
• Thomas Benedetti
• Sherilynn Casey
(2004)
• Kathy Chapman
• Jane Dimer
• Thomas Easterling
• Leslee Goetz
• Ann Lima
• Nancy O’Brien Abel
•
•
•
•
•
•
•
Dale Reisner
Melissa Schiff
Polly Taylor
Danae Steele (2001)
Carla Syverson
Cathy Wasserman
Jeanette Zaichkin (2001)
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Introduction
• Concerns were raised in late 1990s about
maternal mortality in WA and whether it was
increasing.
• Death certificates at that time were known to
undercount maternal deaths.
• Perinatal Advisory Committee convened a
subcommittee to explore maternal mortality
surveillance in 1999.
• Initial findings presented in 2001 and again in
2004, but methodology was incomplete.
• Ascertainment methodology now complete for
1990-2005.
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Definitions
• A Pregnancy-Associated Death is the death of
a woman while pregnant or within a year of
delivery or termination of pregnancy from any
cause.
• A Pregnancy-Related Death is the death of a
woman while pregnant or within a year of
delivery or termination of pregnancy from any
cause related to or aggravated by pregnancy
or its management.
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
On Average 7 deaths reported per year
3 Year Maternal Mortality Ratio
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0.0
1990
Deaths per 100,000 Livebirths
Pregnancy-Related Mortality in Washington
Maternal Mortality Ratio
Maternal Mortality Ratio – 8.3 deaths per 100,000 live births
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Pregnancy-Related Deaths by Cause
Washington, 1990-2005
MMR 7-8/100,000
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Preventability of Pregnancy-Related Deaths
Washington, 1990-2005
Cause of Death
Infection
Cardiac/Cardiovascular
Deep Vein Thrombosis
Amniotic Fluid Embolism
OB Hemorrhage
Hypertension
CNS/CVA
Anesthesia
Other Cause
Don't Know
Total
Total
Deaths
Preventable
Deaths
Possibly
Preventable
Deaths
19
19
13
12
12
9
7
2
9
3
1
2
0
1
5
9
0
2
2
0
16
8
2
2
6
0
1
0
5
3
2
9
11
9
1
0
6
0
2
0
105
22
43
40
Pregnancy-Related Mortality Ratio =
If remove 22 preventable deaths =
105
1,272,309
83
1,272,309
Not
Preventable
Deaths
= 8.3 per 100,000 livebirths
= 6.5 per 100,000 livebirths
If remove 65 preventable and possibly preventable deaths
=
40
1,272,309
= 3.1 per 100,000 livebirths
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Maternal Mortality
Washington State
2009-2012
preliminary analysis
Births 350,306
Minimum Maximum
Pregnancy Related Deaths
32
47
MMR/1000,000 live births
9.1
10.6
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Washington State
7-8
1990 to
2005
9.1
2009 to
2012
Washington
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Maternal Mortality
Washington State
2009-2012
preliminary analysis
Births 350,306
AFE
N
1
MMR 0.29
/year 0.25
N
MMR
/year
CNS
3
0.86
CV
14
4.0
Arryth
2
0.57
CM
7
2.0
0.75
3.5
0.5
1.75
MI pHTN
2
1
0.57 0.29
0.5
0.25
Hem
3
0.86
Ectopic
4
1.14
Inf
1
0.29
H1N1
2
0.57
PreE
2
0.57
PE
3
0.86
0.74
1.0
0.25
0.5
0.5
0.75
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015
Washington State 2009-2012
Hemorrhage
*
9.4%
0.75/yr
Hypertension Infection*
9.4%
3.1%
0.75/yr
0.25/yr
Pulm Emb
9.4%
0.75/yr
AFE
3.1%
0.25/yr
CardioVasc
44%
3.5/yr
CM
22%%
1.75/yr
CVA
9.4%
0.75/yr
Presented at the Washington State Hospital Association – Safe Deliveries Safe Table – Feb. 10, 2015