Center for Healthcare Value and Equity, Section of Community and Population Medicine, Department of Medicine, the Department of Obstetrics & Gynecology, and the Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, the Bureau of Family Health, Office of Public Health, Louisiana Department of Health, the Mary Amelia Community Women's Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, and the Louisiana Department of Health, Baton Rouge, Louisiana.
Obstet Gynecol. 2020 Feb;135(2):276-283. doi: 10.1097/AOG.0000000000003591.
To examine preventable pregnancy-related deaths in Louisiana by race and ethnicity and maternal level of care to inform quality improvement efforts.
We conducted a retrospective observational descriptive analysis of Louisiana Pregnancy-Associated Mortality Review data of 47 confirmed pregnancy-related deaths occurring from 2011 to 2016. The review team determined cause of death, preventability, and contributing factors. We compared preventability by race-ethnicity and maternal level of care of the facility where death occurred (from level I: basic care to level IV: regional perinatal health center) using odds ratios (ORs) and 95% CIs.
The rate of pregnancy-related death among non-Hispanic black women (22.7/100,000 births, 95% CI 15.5-32.1, n=32/140,785) was 4.1 times the rate among non-Hispanic white women (5.6/100,000, 95% CI 2.8-10.0, n=11/197,630). Hemorrhage (n=8/47, 17%) and cardiomyopathy (n=8/47, 17%) were the most common causes of pregnancy-related death. Among non-Hispanic black women who experienced pregnancy-related death, 59% [n=19] of deaths were deemed potentially preventable, compared with 9% (n=1) among non-Hispanic white women (OR 14.6, 95% CI 1.7-128.4). Of 47 confirmed pregnancy-related deaths, 58% (n=27) occurred at level III or IV birth facilities. Compared with those at level I or II birth facilities (n=2/4, 50%), pregnancy-related deaths occurring at level III or IV birth facilities (n=14/27, 52%) were not less likely to be categorized as preventable (OR 2.0, 95% CI 0.5-8.0).
Compared with non-Hispanic white women, pregnancy-related deaths that occurred among non-Hispanic black women in Louisiana from 2011 to 2016 were more likely to be preventable. The proportion of deaths that were preventable was similar between lower and higher level birth facilities. Hospital-based quality improvement efforts focused on addressing hemorrhage, hypertension, and associated racial inequities may prevent pregnancy-related deaths in Louisiana.
通过种族和民族以及产妇护理水平来研究路易斯安那州可预防的妊娠相关死亡，以指导质量改进工作。
我们对路易斯安那州妊娠相关死亡率审查数据进行了回顾性观察描述性分析，该数据包含了 2011 年至 2016 年间发生的 47 例经确认的妊娠相关死亡。审查小组确定了死因、可预防性和导致死亡的因素。我们使用比值比（OR）和 95%置信区间（CI）比较了不同种族-民族和产妇死亡所在医疗机构（从一级：基本护理到四级：区域围产期保健中心）的可预防性。
非西班牙裔黑人妇女的妊娠相关死亡率（22.7/100000 活产，95%CI 15.5-32.1，n=32/140785）是非西班牙裔白人妇女的 4.1 倍（5.6/100000，95%CI 2.8-10.0，n=11/197630）。出血（n=8/47，17%）和心肌病（n=8/47，17%）是妊娠相关死亡的最常见原因。在经历妊娠相关死亡的非西班牙裔黑人妇女中，59%（n=19）的死亡被认为是潜在可预防的，而非西班牙裔白人妇女中只有 9%（n=1）（OR 14.6，95%CI 1.7-128.4）。在 47 例确诊的妊娠相关死亡中，58%（n=27）发生在三级或四级分娩机构。与一级或二级分娩机构（n=4/4，50%）相比，三级或四级分娩机构（n=14/27，52%）发生的妊娠相关死亡不太可能被归类为可预防（OR 2.0，95%CI 0.5-8.0）。
与非西班牙裔白人妇女相比，2011 年至 2016 年期间路易斯安那州非西班牙裔黑人妇女的妊娠相关死亡更有可能是可预防的。较低和较高级别的分娩机构的死亡中可预防的比例相似。以医院为基础的质量改进工作集中解决出血、高血压和相关的种族不平等问题，可能会预防路易斯安那州的妊娠相关死亡。
