Pregnancy-Related Deaths Due to Pulmonary Embolism: Findings from Two State-Based Mortality Reviews

Abstract

This report presents findings from two state-based pregnancy-related reviews of deaths due to pulmonary embolism to describe prevalence, risk factors, and timing of symptoms and fatal events (N=46). We examined the utility of state-based maternal mortality review teams as a means to gain more complete data on maternal deaths from which guidelines for prevention and intervention can be developed. The Florida Pregnancy-Associated Mortality Review Team and Virginia Maternal Mortality Review Team collaborated on findings from 9years of pregnancy-related mortality review conducted in each state. Pregnancy-related deaths due to pulmonary embolism occurring within 42days of pregnancy between 1999 and 2007 in Florida and Virginia were identified. Retrospective review of records was conducted to obtain data on timing of the fatal event in relation to the pregnancy, risk factors, and the presence and timing of symptoms suggestive of pulmonary embolism. Forty-six cases of pregnancy-related death due to pulmonary embolism were identified. The combined pregnancy-related mortality ratio (PRMR) was 1.6/100,000 live births. The PRMR for patients undergoing cesarean section delivery was 2.8 compared to 0.2 among those with vaginal deliveries (95% CI=1.8-4.2 and 0.1-0.5 respectively). Women aged 35 and older had the highest PRMR at 2.6/100,000 live births. BMI over 30kg/m(2) and presence of chronic conditions were frequently identified risk factors. One in five decedents (21.7%) reported at least two symptoms suggestive of pulmonary embolism in the days before death. This combined state-based maternal death review confirms age over 35years, obesity, and the presence of chronic conditions are risk factors for pregnancy-related mortality due to venous thromboembolism in the US. Expanding and standardizing the process of state-based reviews offers the potential for reducing pregnancy-related mortality in the US.