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Abstract

We thank Marasinghe et al for their letter and positive comments regarding our analysis in the article “Reliability of a preventability model in maternal death and morbidity.”1Geller S.E. Adams M.G. Kominiarek M.A. et al.Reliability of a preventability model in maternal death and morbidity.Am J Obstet Gynecol. 2007; 196: 57e.1-57e.6Abstract Full Text Full Text PDF Scopus (46) Google Scholar As stated in the article, we found that patient factors played a relatively small role in the overall issue of preventability. Therefore, we chose to report on provider and system preventable factors, which had a much greater impact on the progression of illness. In a previously published analysis, we found that provider factors were present in 90% of the morbidities and deaths we studied, whereas patient factors occurred in 13-20%.2Geller S.E. Rosenberg D. Cox S.M. et al.The continuum of maternal morbidity and mortality: factors associated with severity.Am J Obstet Gynecol. 2004; 191: 939-944Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar Furthermore, we found that these patient factors did not contribute to the progression of maternal morbidity after controlling for sociodemographic characteristics. Revisiting the data collected for the validation study, we did find 88% agreement between the 2 review groups on the presence of patient factors (kappa = 0.61; P < .0001), indicating substantial agreement.3Landis J.R. Koch G.G. The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174Crossref PubMed Scopus (49726) Google ScholarIn our sample, the most common patient factor identified was noncompliance with medical advice (7% of all cases). Failure to seek care (3%) and inadequate prenatal care (4%) were also noted. Substance abuse (5% of all cases) was also an issue in our population. We agree that violence against women deserves further attention, although in our sample there were no reported cases. More research is clearly needed to characterize all preventable causes of maternal morbidity and mortality. Studies performed among different populations and with larger sample sizes is the first step in reducing maternal illness and death. We thank Marasinghe et al for their letter and positive comments regarding our analysis in the article “Reliability of a preventability model in maternal death and morbidity.”1Geller S.E. Adams M.G. Kominiarek M.A. et al.Reliability of a preventability model in maternal death and morbidity.Am J Obstet Gynecol. 2007; 196: 57e.1-57e.6Abstract Full Text Full Text PDF Scopus (46) Google Scholar As stated in the article, we found that patient factors played a relatively small role in the overall issue of preventability. Therefore, we chose to report on provider and system preventable factors, which had a much greater impact on the progression of illness. In a previously published analysis, we found that provider factors were present in 90% of the morbidities and deaths we studied, whereas patient factors occurred in 13-20%.2Geller S.E. Rosenberg D. Cox S.M. et al.The continuum of maternal morbidity and mortality: factors associated with severity.Am J Obstet Gynecol. 2004; 191: 939-944Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar Furthermore, we found that these patient factors did not contribute to the progression of maternal morbidity after controlling for sociodemographic characteristics. Revisiting the data collected for the validation study, we did find 88% agreement between the 2 review groups on the presence of patient factors (kappa = 0.61; P < .0001), indicating substantial agreement.3Landis J.R. Koch G.G. The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174Crossref PubMed Scopus (49726) Google Scholar In our sample, the most common patient factor identified was noncompliance with medical advice (7% of all cases). Failure to seek care (3%) and inadequate prenatal care (4%) were also noted. Substance abuse (5% of all cases) was also an issue in our population. We agree that violence against women deserves further attention, although in our sample there were no reported cases. More research is clearly needed to characterize all preventable causes of maternal morbidity and mortality. Studies performed among different populations and with larger sample sizes is the first step in reducing maternal illness and death. Reliability of a preventability model in maternal death and morbidity needs further assessmentAmerican Journal of Obstetrics & GynecologyVol. 197Issue 4PreviewToday we witness a heightened awareness of the global problem of maternal morbidity and mortality. From multiple sources, efforts are being made to reduce this global toll. The work by Geller et al1 merits appreciation because it seems to have successfully measured the reliability of a model that defines preventability in maternal morbidity and mortality with high agreement between the 2 independent groups of medical experts who identified potentially preventable system errors. Full-Text PDF