State committee expected to find many more maternal mortality cases
In the state’s first-ever attempt at documenting exactly how many women in Pennsylvania have died from pregnancy-related causes, it already has identified significantly more potential cases than the less rigorous process the state has used for decades, said a member of the state’s newly formed Maternal Mortality Review Committee.
“Because previous measures [to count maternal mortality deaths] went to just 42 days [after a pregnancy] and they didn’t include all causes of death, our counts will be higher,” said Carolyn Byrnes, special advisor to Rachel Levine, Pennsylvania’s Secretary of Health.
The committee’s initial search of state vital records data linked about 100 baby birth certificates to women who died in 2018 within one year of giving birth. That data does not include Philadelphia, which has its own review committee.
The actual number of women who will be counted by the state as a pregnancy-related death likely will be much smaller than 100, but probably much higher than the nine to 20 maternal mortality cases the state identified annually over the last decade using a less rigorous process.
Detailing how many and why women are dying from pregnancy -related causes has become a national issue as maternal mortality rates have risen dramatically across the country and in Pennsylvania over the last 20 years.
The state’s old process simply collected data from death certificates that had a box checked indicating that the woman who died had been pregnant either within 42 days prior to her death, or up to a year. All of those deaths the state has identified in the past would be considered “pregnancyassociated” but not necessarily “pregnancy-related,” meaning their death was directly related to having been pregnant.
But experts have long believed that the state’s rudimentary system of counting maternal mortality was inadequate since it relied solely on the knowledge of the woman’s history by the person who signed the death certificate, and researching whether she had been pregnant was not required.
“I am thinking [the state’s count] has been wildly underreported for years,” said Dr. Aasta Mehta, the women’s health policy advisor to the Philadelphia Department of Health and a member of both that city’s review committee and now the statewide committee.
Philadelphia discovered that when it formed its own review committee in 2010. The report it published in 2015 on three years of city maternal mortality data from 2010 to 2012, found that the state’s own count of just 15 pregnancy-associated maternal deaths in the city was lower than the city review committee’s finding of 19 pregnancy-related deaths in that same time period.
Under the state’s new process — based partially on the Philadelphia model — that was approved by state legislators just last year, every one of the 100 pregnancy-associated cases will be reviewed by the 31-member state committee to see if they are pregnancy-related.
Committee members, made up of people with various backgrounds related to death investigations and women’s health, will consider medical records and the circumstances of each woman’s death.
Starting the process
That process began with the committee’s first-ever case review meeting on July 24 in Harrisburg.
Because it was the first such meeting the committee has ever held, the six-hour-long session only got through six of the cases, Ms. Byrnes said.
“It’s obviously a hard thing to do [to review so many women’s deaths] and can be emotionally draining,” Ms. Byrnes said. “But reminding ourselves of the goal and the purpose helped propel it forward.”
The committee’s purpose also got a big assist recently when the federal Centers for Disease Control and Prevention awarded Pennsylvania a $2.25 million grant over the next five years. The money will pay to hire a full-time program administrator, a full-time epidemiologist, and a part-time nurse.
The nurse will join the committee’s only current, full-time employee, a nurse who writes summaries of each maternal mortality case before they are given to the committee members to decide if their deaths were pregnancy-related.
It took the committee’s current nurse about four months, beginning in late February, to request all the medical and death records on each case, and then write the summaries, Ms. Byrnes said.
The summaries were handed out before the July 24 meeting for members to read. Then, during the meeting chaired by Stacy Beck, an obstetrician-gynecologist at Magee-Women’s Hospital of UPMC, an overview was given before committee members weighed in with comments and questions, Dr. Mehta said.
“The conversation was really rich,” she said. “It went really, really well.”
No formal vote was taken to determine whether a case was pregnancy-related, Dr. Mehta said. Instead, members tried to reach a general consensus.
The committee will hold quarterly meetings, including its next one in October. But it may hold more if needed, Ms. Byrnes said, in order to complete the review of each of the summaries over the next 16 months.
Completing the reviews by the end of next year is the goal because the CDC expects review committees to analyze pregnancy-related deaths within two years of each death, she said.
“We will get more efficient as we are all more familiar with the review process,” Dr. Metha said. “But you also want to make sure you give each case its due. Because the goal is to eventually come up with a recommendation on how the system could be improved to prevent similar deaths from occurring in the future.”