58 PREGNANCY-RELATED DEATH (PRD) REVIEW OF TEN YEARS-FLORIDA 2009–2018

Abstract

The Florida Pregnancy Associated Mortality Review (PAMR) Committee reviews all PRDs with the goal to identify opportunities for prevention. The objective is to report current Pregnancy Related Mortality Ratio (PRMR) trends 2009-2018 and recommendations for practice. PAMR identifies all pregnancy associated deaths (PADs) by linkage to multiple files. Records of possible PRDs are abstracted, reviewed, and assessed. PAMR and birth certificate records from 2009–2018 were examined for PRMR estimates, trends and risk factors. Florida had 408 PRDs for 2,191,578 live births. The PRMR fluctuated from 26.2 deaths per 100,000 live births in 2009, to 12.9 in 2016. The 2018 PRMR is 16.3 on a downward trend from 2009-2018 but not significant (p>0.05.) The overall PRMR decreased 29% from 21.8 in 2009-13 to 15.5 in 2014-18 (p=0.001). PRMRs were calculated to evaluate race/ethnicity changes during the same intervals. The Non-Hispanic (NH) Black decreased significantly 37% from 46.6 to 29.4 (p=0.002). The Hispanic 42% decrease from 12.8 to 7.41 was significant (p=0.04). The NH White 9% decrease from 15.8 to 14.5 (p=0.59) was not significant. The Black/White disparity ratio decreased from 2.9x to 2.0x (p<0.05). From 2009-2018, six causes of death accounted for 77.7% of PRDs in rank order: hemorrhage, infection, hypertensive disorders, cardiomyopathy, cardiovascular and thrombotic embolism. Risk factors all not adjusted associated with PRD were cesarean delivery (RR 3.3), age 35 or older (RR 2.7), obesity (RR 2.6), no prenatal care during the first trimester (RR 2.4), non-Hispanic black (RR 2.5), and high school or less education (RR 1.4). Florida’s PRMR trending downward and the NH Black and Hispanic rates decreasing significantly may reflect statewide efforts of PAMR, the Florida Perinatal Quality Collaborative (FPQC), ACOG District XII and other partners who release this information to practitioners in obstetrics and emergency rooms through Urgent Maternal Mortality Messages and with the FPQC who target and focus on leading causes, risks and prevention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)