Pregnancy-related deaths due to pulmonary embolism: findings from two state-based mortality reviews.

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/m(2) 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.

Psychosocial risk factors as contributors to pregnancy-associated death in Virginia, 1999-2001.

OBJECTIVE: To determine if substance abuse, mental illness, and domestic violence contributed to preventable pregnancy-associated death and to describe characteristics of women for whom these factors contributed to death. METHODS: The medical records of 121 women who had pregnancy-associated deaths in Virginia between 1999 and 2001 were reviewed. The incidence of substance abuse, mental illness, and domestic violence was noted during systematic review. Multidisciplinary review of cases was conducted to determine if these factors contributed to death and if reasonable changes may have prevented death. RESULTS: The pregnancy-associated maternal mortality ratio for women experiencing substance abuse, mental illness, or domestic violence as contributors to death was 17.1. Thus, for every 100,000 live births in Virginia, 17.1 women had at least one of these factors directly contribute to death. Substance abuse contributed to death in 28.9% of all cases reviewed (pregnancy-associated maternal mortality ratio = 12.2); 45.7% of those deaths were considered preventable. Mental illness contributed to death in 16.5% of cases (pregnancy-associated maternal mortality ratio = 6.9), with 50.0% considered preventable. Domestic violence contributed to death in 14.0% of cases (pregnancy-associated maternal mortality ratio = 5.9), with 64.7% of cases considered preventable. Median household incomes and years of education completed varied widely. Pregnancy-associated maternal mortality ratios for each factor were higher among African American women than among white women. CONCLUSIONS: Psychosocial risk assessment with appropriate referral should be completed for all women seeking care regardless of social status, education, or race.

Delayed uterine re-inversion: a unique symptom complex.

A case of late recurrence of uterine inversion is presented. Symptoms included constipation and urinary retention without uterine bleeding. Symptoms resolved 3 months after the replacement of the uterus. It is hypothesized that the symptoms were related to stretch injury to the pelvic parasympathetic nerves. Timely intervention may prevent long-term sequelae.