Maternal Mortality From Hemorrhage in Michigan 1998–2011 [8

Abstract

INTRODUCTION: Obstetric hemorrhage contributes significantly to the burden of maternal mortality. The objective of this study is to examine obstetric hemorrhage deaths in Michigan from 1998–2011 to determine etiology, preventability and modifiable/actionable factors that can be addressed to reduce hemorrhage mortality. METHODS: The records from all pregnancy-associated deaths from January 1, 1998 to December 31, 2011 were examined for the presence of disseminated intravascular coagulopathy, exsanguination, or hemorrhage. Cases were excluded when hemorrhage was not present, the cause of death was not from hemorrhage, or the death was not pregnancy-related. Extracted data included demographic information, details of the hospital course, and the final cause of death and the presence of preventability factors as determined by the State of Michigan Maternal Mortality review committee. RESULTS: Forty six cases of pregnancy related mortality from hemorrhage were identified. Postpartum hemorrhage (PPH) was the etiology with the greatest number of preventable deaths (7 of 12 total cases). Fifty percent of hemorrhage cases were considered to be preventable, 35% were considered to be not preventable, and 15% were not determined. In all cases where blood transfusion occurred, fresh frozen plasma transfusion was either absent or given at rates lower than currently recommended. CONCLUSION/IMPLICATIONS: Half of pregnancy related deaths from obstetric hemorrhage in Michigan were potentially preventable. Aggressive diagnosis and treatment of postpartum hemorrhage offers the best opportunity for prevention, and statewide educational programing to ensure proper administration of blood products is a necessary step to improving the quality of care and safety of childbirth.