CDC says large number of pregnancy related deaths could be prevented

By Dr. Ananya Mandal, MDMay 8 2019

The Centres for Disease Prevention and Control (CDC) has released a Vital Signs report that says that at least three in five pregnancy related deaths are preventable. Pregnancy related deaths include deaths cause before, during or up to one year after delivery. Pregnancy related deaths are those that are caused by reasons which are linked to or result from complications directly associated with pregnancy. It could be a chain of events that are triggered or activated by the pregnancy, its physiological effects and its complications.

The report says that around 700 pregnancy related deaths are recorded in the United States. Of these 31 percent occur during pregnancy, 36 percent occur during delivery or childbirth and within a week after delivery. A further 33 percent of the deaths can occur within the period of one week after delivery and up to one year post-delivery.

The CDC looked at pregnancy related mortality and morbidity data between 2011 and 2015. They also analysed details of pregnancy related deaths from maternal mortality review committees across 13 states between 2013 and 2017.

The results revealed that among a heterogenic population, the risk of dying due to pregnancy related complications is around three times more likely among the Black and American Indian/Alaska Native women compared to Caucasian women. The key point that was noted by the researchers was that most of these deaths were preventable irrespective of the race and ethnicity.

According to a statement from Robert R. Redfield, M.D., CDC Director, “Ensuring quality care for mothers throughout their pregnancies and postpartum should be among our Nation’s highest priorities. Though most pregnancies progress safely, I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventative care that can and does save lives.”

This Vital Signs report remains the latest data on CDC’s Pregnancy Mortality Surveillance System and also summarized the recommendations in prevention of deaths of the mothers due to pregnancy related causes. Maternal mortality review committees or MMRCs from 13 states involve specialists from different disciplines and the recommendations in preventing or reducing mortality rates among mothers is provided by these experts. The experts have said that several factors are associated with the maternal deaths. Some of these include lack of access to adequate health care facilities, delayed or missed diagnosis of pregnancy related emergencies, lack of knowledge among the patients as well as health care providers. The MMRCs say that most of these deaths could have been prevented.

The report says that the commonest causes of pregnancy related deaths in the nation are due to heart attack, heart disease or stroke causing around 34 percent of all deaths. Severe bleeding and infections are also a major cause of deaths during and after pregnancy and childbirth. At delivery the commonest causes of death include severe bleeding and amniotic fluid embolism. Amniotic fluid embolism is caused when amniotic fluid from the womb enters the mother’s blood stream during child birth. Commonest causes of deaths during the week after delivery include bleeding, high blood pressure and infections. Deaths during the period up to 1 year after delivery include cardiomyopathy or weakening of the heart muscles.

Wanda Barfield, director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention and Health Promotion in her statement said, “Our new analysis underscores the need for access to quality services, risk awareness, and early diagnosis, but it also highlights opportunities for preventing future pregnancy-related deaths. By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives.”

According to the recommendations the MMRC data suggests awareness regarding warning signs and ongoing conversations on the part of the providers. The recommendations state that hospitals and healthcare systems can encourage communication between healthcare providers and improve quality of care before, during and after delivery.  Communities and state can contribute in providing adequate housing and transportation especially for high risk pregnancies. Above all, prevention rests on awareness and knowledge of the warning signs, says the report.

The actions taken by the CDC with regards to prevention of maternal deaths include –

• Tracking of all maternal deaths related to pregnancy and associated complications
• Support to around 25 MMRCs around the nation via funding from the “Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees” stating fall 2019
• Supporting 13 state perinatal quality collaboratives for improvement of health of the newly delivered mothers and their babies
• Development of the CDC Levels of Care Assessment Tool to assess the level of maternal and new born care provided by the health care setups and providing technical assistance.
• Public awareness programmes regarding warning signs of high risk pregnancies

The three key recommendations from the report include, “During Pregnancy: Improve access to and delivery of quality prenatal care, which includes managing chronic conditions and educating about warning signs. At Delivery: Standardize patient care, including delivering high-risk women at hospitals with specialized providers and equipment and Postpartum: Provide high-quality care for mothers up to one year after birth, which includes communicating with patients about warning signs and connecting to prompt follow-up care.”

Public Health Grand Rounds is yet another effort on the part of the CDC to reduce pregnancy related deaths by raising awareness. It is a monthly webcast that discusses major health issues. The CDC along with collaborators also started “Review to Action”, a website that had resources to support MMRCs. It contains a Maternal Mortality Review Information Application (MMRIA), which is a data entry system that can provide detailed data on maternal mortality.