Pregnancy-Related Deaths Due to Cardiomyopathy - Florida,
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1 Pregnancy-Related Deaths Due to Cardiomyopathy - Florida,
2 THE FLORIDA PREGNANCY-ASSOCIATED MORTALITY REVIEW (FL-PAMR), Funded through Title V MCH Block Grant
3 FL-PAMR HISTORY In 1996, The Florida Department of Health initiated the Pregnancy-Associated Mortality Review (PAMR) to improve surveillance, analysis and prevention of pregnancy-related mortality. The primary focus of PAMR is to review all deaths identified as pregnancy-related. In 1999, FL-PAMR report 3
4 FL-PAMR Committee, current Donna Barber, R.N., M.P.H.; Children s Medical Services, Department of Health (DOH) Rhonda Brown, R.N., B.S.N.; Children s Medical Services, (DOH) Deborah Burch, R.N., B.S., C.P.C.E.; PAMR Coordinator, Infant Maternal and Reproductive Health, (DOH) Ed Carney, M.D., American College of Obstetrics and Gynecology (ACOG) Fellow Isaac Delke, M.D.; University of Florida, (ACOG) Linda Enfinger, R.N., M.S.W.; Agency for Health Care Administration (AHCA) Karen Freeman, M.S., M.P.H.; Office of Planning, Evaluation, and Data Dave Goodman, M.S., Ph.D.; Office of Surveillance, Evaluation and Epidemiology, (DOH) Miriam Gurniak, C.N.M.; Azalea Women s Healthcare Washington Hill, M.D.; Director, Maternal Fetal Medicine Sarasota Memorial Hospital Joan Hulett, R.N.C.; Florida Chapter (AWHONN) Laura Levine, R.N., B.S.N.; Infant Maternal and Reproductive Health, (DOH) Charles Mahan, M.D., University of South Florida, Lawton and Rhea, Chiles Center Jane Murphy, Executive Director, Healthy Start Coalition of Hillsborough County Dani Noell, M.S.N., A.R.N.P., R.N.C.; PAMR Abstractor Margaret Neal, M.D.; Pathology Associates, Medical Examiner s Commission Annette Phelps, A.R.N.P., Director, Division of Family Health Services (DOH) Susan Potts, L.C.S.W.; Infant Maternal and Reproductive Health, (DOH) Bill Sappenfield, M.D., M.P.H.; Office of Surveillance, Evaluation and Epidemiology, DOH Dearline Thomas-Brown, R.N., B.S.N.; Infant Maternal and Reproductive Health, (DOH) Angel Watson, M.P.H., R.H.I.A.; Office of Surveillance, Evaluation and Epidemiology, (DOH) Betsy Wood, B.S.N., M.P.H.; Infant Maternal and Reproductive Health, (DOH) Robert Yelverton, M.D.; CEO, Medical Director, Tampa Bay Women s Care 4
5 Process of the Pregnancy-Associated Mortality Review 5
6 Stage 1: Identification of Pregnancy-Associated Deaths and Selection of PAMR Cases MATERNAL DEATH CERTIFICATES MATCHING BIRTH CERTIFICATES MATCHING FETAL DEATH CERTIFICATES MATCHING HS PRENATAL SCREEN ICD 10 UNDUPLICATED POOL OF PREGNANCY- ASSOCIATED DEATHS PREGNANCY BOX SORTED BY M.D. REVIEW PREGNANCY- RELATED POSSIBLY PREGNANCY-RELATED NOT PREGNANCY- RELATED ALL CASES RANDOM SELECTION PREGNANCY-RELATED POSSIBLY PREGNANCY-RELATED NOT PREGNANCY- RELATED
7 PAMR CASES (DEATH CERTIFICATES, BIRTH CERTIFICATES, HS SCREENING RECORDS) Stage 2: The PAMR Process DE-IDENTIFIED DEMOGRAPHICS ABSTRACTION PROCESS DE-IDENTIFIED NARRATIVE SUMMARY OBJECTIVE DATA TEAM EVALUATION PAMR DATABASE DEMOGRAPHICS EVALUATIVE DATA OBJECTIVE DATA
8 Stage 3: PAMR Process Findings to Actions Identification of Issues Recommendations for Improvements/Interventions Assigned to Improvement Categories: Clinical Quality of Care Healthcare System Individual / Community Death Review Process Dissemination of Findings: Conferences Continuing Education Forums Medical and Nursing publications Web casts, media spots, electronic newsletters
9 Pregnancy-Related Mortality Ratios by Race/Ethnicity Florida, year PRMR Non-Hispanic Black Non-Hispanic White Hispanic 9
10 Distribution of Causes of Pregnancy- Related Deaths - Florida, Other 12.8% Unknow n 4.0% Hypertensive disorder 15.3% Intracerebral hemorrhage 3.4% Ammiotic fluid embolism 7.0% Hemorrhage 15.1% Other cardiovascular problems 8.7% Thrombotic embolism 9.8% Cardiomyopathy 10.9% Infection 13.0% 10
11 Distribution of Five Leading Causes of Pregnancy-Related Deaths Florida, Thrombotic embolism 9.8% Hypertensive disorder 15.3% Cardiomyopathy 10.9% Hemorrhage 15.1% Infection 13.0% 11
12 Causes of Pregnancy-Related Death by Time After Delivery Florida, Days After Delivery Less N/A* N/I** Total Hypertensive disorder Hemorrhage Infection Cardiomyopathy Thrombotic embolism Other cardiovascular Problems Amniotic fluid embolism Intracerebral hemorrhage Other Unknown Total * No applicable. ** Unknown
13 Pregnancy-Related Deaths Due to Cardiomyopathy by Time After Delivery,* Florida, Interval (d) Cardiomyopathy, n (%) Undelivered 3 (6) (16) (18) (14) (46) *Among those with known delivery time. NOTE: 47/50 (94%) died postpartum; 23/47 (48.9%) deaths >6 weeks after delivery! 13
14 Pregnancy-Related Deaths Due to Cardiomyopathy by Time After Delivery,* Florida, VS CDC, Interval (d) Cardiomyopathy FL (N=50), n (%) Undelivered 3 (6) 2 (1.7) Cardiomyopathy CDC (N=120), n (%) (16) 22 (18.3) (18) 13 (10.8) (14) 23 (19.2) (46) 60 (50) 44 (36.7) [44/60 (73.3)] 16 (13.3) *Among those with known delivery time. 14
15 Pregnancy-Related Deaths Due to Cardiomyopathy by Age, Race and BMI,* Florida, Characteristics Age < >35 Race White non-hispanic Black non-hispanic Hispanic BMI* Underweight Normal Overweight Obese Cardiomyopathy n (%) 17 (33.3) 26 (51.0) 8 (15.7) /51(82) PRMR or % % 63% 8% 4.8% 9.5% 23.8% 61.9% 15
16 Pregnancy-Related Deaths Due to Cardiomyopathy by Parity and Prenatal Care,* Florida, Characteristics Cardiomyopathy n (%) Parity* 46/51 (90.2) Nulliparous 1/46 (2.2) 1 20 (43.5) >2 25 (54.3) Prenatal Care* First trimester Second-Third trimester No prenatal care 41/51 (80.4) 26/41 (63.4) 13/41 (31.7) 2/41 (4.9) Among those known. 16
17 Pregnancy-Related Deaths Due to Cardiomyopathy by Hospital Level and Delivery Mode,* Florida, Characteristics Cardiomyopathy, n (%) Hospital level Mode of delivery* Vaginal Planned CD Unplanned CD 11/45 (24.4) 8/45 (17.8) 26/45 (57.8) 19/45 (42.2) 8/45 (17.8) 18/45 (40.0) Among those known and undelivered (3). 17
18 Conclusions: Cardiomyopathy Findings: Cardiomyopathy was the cause of pregnancy-related deaths after 42 days postpartum in nearly half of the cases! Recommendations: Enhance postpartum care with Case management / coordination of care with primary healthcare providers/cardiology/patient education for compliance, etc. 18
19 Conclusions: Cardiomyopathy Findings: Black, obese, and multiparous women were at increased risk of deaths due to cardiomyopathy. Recommendations: Provision of preconception counseling/access to family planning services, as part of primary care, to patients with chronic medical conditions including cardiac disease(s). Increased community (both patient/family) awareness of pregnancy-associated risks of women with cardiac disease(s). 19
20 ACKNOWLEDGEMENTS Special thanks to FL-PAMR Committee members. Without their diligent work, expertise, and commitment, this process and report would not have been possible.
21 For Further Information: Contact: Deborah Burch R.N., M.S.N. Florida PAMR Coordinator (850) , ext
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