Friday, February 8, 2013

Lady Sybil’s Tragic Death and the Current Problem of Maternal Mortality

By Lisa Hollier, MD, MPH, FACOG

Chair, American Congress of Obstetricians and Gynecologists District 11 (Texas)

Fans of the BBC historical drama, Downton Abbey, have been grieving Lady Sybil’s tragic maternal death. As the details are revealed, it appears that she may have died from complications of preeclampsia, also known as high blood pressure of pregnancy. Perhaps the saddest news of all is that a mother’s death from this pregnancy complication isn’t relegated to the annals of history, but it continues to happen today even in our best medical centers. In fact, here in Texas, high blood pressure of pregnancy, including preeclampsia and eclampsia, are among the current leading causes of death associated with pregnancy.

Pregnancy-associated death
means the death of a woman while pregnant or within one year of the end of a pregnancy regardless of the cause of death or outcome of the pregnancy. An example would be a motor-vehicle accident. A pregnancy-related death means a death during or within one year of pregnancy that was caused by a complication of pregnancy, a chain of events initiated by pregnancy, or aggravation of an unrelated condition or event by the physiologic effects of pregnancy. Examples would include suicide from postpartum depression and death from liver failure from preeclampsia.

We have a major problem with maternal death in Texas, and maternal mortality is one of the most striking health disparities. The pregnancy-associated mortality rate has been rising since 1996 —quadrupling over that time. In 2010, the statewide pregnancy-associated mortality rate was 24.6 per 100,000 live births. Black women in Texas are at least three times more likely to die from pregnancy complications than are white women.

British women like Lady Sybil have a distinct advantage over Texas women. For more than 100 years, concerned local obstetricians, midwives, and public health officials in the United Kingdom have systematically reviewed deaths associated with pregnancy in a process referred to as “enquiry.” The implementation of the recommendations and guidelines from the published reports have improved policies, procedures, and practice and saved mothers’ and babies’ lives.

Texas does not have a state-wide review process despite having a high number of maternal deaths in the U.S. compared to other states each year. When even a small airplane goes down, there is a thorough investigation by the Federal Aviation Administration. Right now, we lose the equivalent of a loaded 747 aircraft every year to maternal death without any systematic investigation to understand the cause and prevent future deaths. During this legislative session, we have an opportunity to implement a state-based review that systematically combines reviews of all the maternal deaths in the state, allows robust analyses to identify systemic problems, and provides a baseline that can be used to monitor interventions that are implemented to reduce maternal death and severe complications.

Let’s move Texas into the 21st century. The time to do something important about maternal mortality is NOW. Show your support for a statewide maternal mortality review process.

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