Abstract

Purpose: To analyze publicly available data to evaluate the recent prevalence of maternal mortality in Texas and map locations with high maternal mortality. Through expansion of the concept of failure to rescue (FTR), a public health approach to maternal mortality was applied that incorporated drug overdose, homicide, and suicide. These three previously overlooked causes of mortality often occur after the 42-day postpartum period.

Methodology: Using a descriptive, epidemiological, and cohort design, we analyzed birth and death certificate data for Texas, 2013 through 2015. We applied the formula for FTR used by the National Quality Measures Clearinghouse and expanded the definition of maternal FTR to include deaths from overdose, homicide, and suicide (psychological variables) along with deaths from the 7 major obstetrical risk factors (physiological variables) previously associated with maternal death. These include chronic hypertension, preeclampsia, eclampsia, diabetes, gestational diabetes, hemorrhage, and cesarean delivery.

Results: Analyzing 1,218,205 births, we identified 713 maternal mortalities. We found strong spatial differences in maternal mortality, with one rural county having a rate of 10% of all births and a major urban county with a rate of .0006%. Of 713 deaths, 475 (66.6%) had obstetrical risk factors as the underlying cause, leaving 238 deaths from other causes. Of those 238, 40 mothers died from suicide, opioid overdose, or homicide. We obtained an unrefined FTR rate of 96 maternal deaths/100,000 births. By expanding the definition of FTR and adding 40 cases of suicide, overdose, or homicide to the 475 cases with physiological complications, we obtained a FTR rate of 104 deaths/100,000 births (an 8% increase). The usual hospital FTR focuses on common obstetrical complications and restricts thinking to hospital-based remedies. Yet, 40 mothers had died from intentional violence, suicide, or drug overdose. These causes of death required services above and beyond those offered at the time of delivery and included transportation, crisis intervention, community-based drug treatment, and accessible mental health services. When planning population-level interventions, consideration of only those complications amenable to hospital-based services would fail to recognize the full range of services needed to reduce FTR and maternal mortality, furthering promotion of maternal health.

Author Details

Peggy Mancuso, PhD, RN, CNM; Elizabeth Restrepo, PhD, RN; Fuqin Liu, PhD, RN; Patti Hamilton, PhD, RN

Sigma Membership

Non-member

Lead Author Affiliation

Texas Woman's University, Denton, Texas, USA

Type

Poster

Format Type

Text-based Document

Study Design/Type

N/A

Research Approach

N/A

Keywords:

Maternal Mortality, Maternal Morbidity, Failure to Rescue

Conference Name

21st Annual NPWH Premier Women's Healthcare Conference

Conference Year

2018

Conference Location

San Antonio, Texas, USA

Conference Host

National Association of Nurse Practitioners in Women's Health

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

Abstract Review Only: Reviewed by Event Host

Acquisition

Proxy-submission

Full Text of Presentation

wf_yes

Download

Share

COinS