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 9 years of pregnancy-related mortality review conducted in each state. Pregnancy-related deaths due to pulmonary embolism occurring within 42 days 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 30 kg/m2 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 35 years, 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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Berg, C. J., Callaghan, W. M., Syverson, C., & Henderson, Z. (2010). Pregnancy-related mortality in the United States, 1998–2005. Obstetrics and Gynecology, 116, 1302–1309.
United States Department of Health and Human Services (US DHHS). (2005). Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data 1998–2005, on CDC WONDER Online Database, November 2005. Accessed at http://wonder.cdc.gov/natality.html on July 18, 2012.
Clark, S. L., Belfort, M. A., Dildy, G. A., Herbst, M. A., Meyers, J. A., & Hankins, G. D. (2008). Maternal death in the 21st century: Causes, prevention, and relationship to cesarean delivery. American Journal of Obstetrics Gynecology, 199, 36.
The Joint Commission. (2010). Sentinel event alert: Preventing maternal death. Issue 44, January 26, 2010.
American College of Obstetricians and Gynecologists. (2011). Thromboembolism in pregnancy. Practice Bulletin No. 123. Obstetrics and Gynecology, 118, 718–729.
Lewis, G. (2011). Maternal death enquiries. In Centre for Maternal and Child Enquiries http://www.cemach.org.uk/Projects/Maternal-and-Perinatal-Health/Maternal-Death-Enquiry.aspx. Retrieved May 18, 2011.
Saving Mothers’ Lives. (2011). Reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG, 118(Suppl. 1), 1–203.
Berg, C., Danel, I., Atrash, H., Zane, S., & Bartlett, L. (Eds.). (2001). Strategies to reduce pregnancy-related deaths: From identification and review to action. Atlanta: Centers for Disease Control and Prevention.
Royal College of Obstetricians and Gynecologists. (2009). Thrombosis and embolism during pregnancy and the puerperium, reducing the risk (Green-top 37a). Retrieved Mar 29, 2011, from http://www.rcog.org.uk/womens-health/clinical-guidance/reducing-risk-of-thrombosis-greentop37a.
Casele, H. L., & Grobman, W. A. (2007). Management of thromboprophylaxis during pregnancy among specialists in maternal-fetal medicine. Journal of Reproductive Medicine, 52(12), 1085–1089.
James, A. H., Jamison, M. G., Brancazio, L. R., & Myers, E. R. (2006). Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. American Journal of Obstetrics and Gynecology, 194(5), 1311.
Knight, M. On behalf of UKOSS. (2008). Antenatal pulmonary embolism: risk factors, management and outcomes. BJOG, 115, 453–461.
Larsen, T. B., Sorensen, H. T., Gislum, M., & Johnsen, S. P. (2007). Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: A population-based nested case-control study. Thrombosis Research, 120(4), 505–509.
United Nations Statistics. (2011). About the millennium development goals. Available at: http://unstats.un.org/unsd/mdg/Host.aspx?Content=Indicators/OfficialList.htm. Retrieved July 24, 2011.
Acknowledgments
We gratefully acknowledge the contributions of members of Virginia Maternal Mortality Review Team and Florida Pregnancy-Associated Mortality Review. This report was supported in part by grants from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, US Department of Health and Human Services.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Heyl, P.S., Sappenfield, W.M., Burch, D. et al. Pregnancy-Related Deaths Due to Pulmonary Embolism: Findings from Two State-Based Mortality Reviews. Matern Child Health J 17, 1230–1235 (2013). https://doi.org/10.1007/s10995-012-1117-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-012-1117-5