Public Health. She told lawmakers a task force could identify gaps in services and systems to prevent future deaths and complications and to disseminate find- ings and recommendations. “By clearly identifying preventable causes of death and complications, we can better direct resources to improve health for women while reducing health care costs — the best of both worlds,” Dr. Hollier testified. Dr. Ortique says ACOG has long pri- oritized the reduction of the maternal mortality rate in the United States and started calling for state maternal mortal- ity review boards around 2010. Dr. Hilliard says that for every ma- ternal death, an estimated 50 pregnant women have near-death complications. “We need to know what is contribut- ing to this problem, and we need to look at this from a public health standpoint. Doing so will help us identify the factors and correct them,” she said. June Hanke, a nurse and strategic analyst at Harris County Health System, says Illinois’ maternal mortality review board determined postpartum hemor- rhage caused many deaths. “If that were an identified contributing factor here in Texas, we could educate health professionals on appropriate ac- tions to minimize it,” Ms. Hanke said. Dr. Ortique told the reference com- mittee at TexMed that maternal mortal- ity is particularly acute in minority popu- lations. According to ACOG, there were 9.1 deaths nationally per 100,000 live births for white women in 2006, com- pared with 34.8 for African-American women the same year. “Research by the CDC and Hospital Corporation of America indicate Afri- can-American women are three to four times more likely to die from pregnancy- related complications regardless of their socioeconomic status and level of educa- tion,” Dr. Ortique said.
Pinpointing why African-American women have a higher rate of maternal death requires data. “Among African-American women
there’s a higher incidence of obesity and hypertensive disorder, which could be contributing to the maternal death rate. But without data and further study, we
can’t prove that. I’m hopeful the work of the task force will benefit all women in the state, including minority women,” Dr. Ortique said.
She added that the task force’s rec- ommendations related to minority and high-risk patients will raise physician awareness of pregnancy-related health disparities. “If physicians know in advance, for example, that their African-American patients are more likely to suffer compli- cations during pregnancy, they can make different delivery recommendations or triage in advance to ensure these women receive additional medical resources,” Dr. Ortique said.
Studying maternal death causes Why Texas’ maternal mortality rate tow- ers above the U.S. average isn’t clear. Dr.
Ortique says the state’s obesity epidemic could provide a clue, but data gathered and analyzed by the task force will help paint a clearer picture of the problem facing Texas women.
Amnesty International has studied
factors contributing to pregnancy-related deaths nationally. Deadly Delivery: The Maternal Health Care Crisis in the USA, a 2010 report by the organization, lists the five main causes of maternal death in this country:
1. Embolism (20 percent), 2. Hemorrhage (17 percent), 3. Preeclampsia and eclampsia (16 per- cent),
4. Infection (13 percent), and 5. Cardiomyopathy (8 percent).
The report recommends that states es-
Maternal deaths rising
The maternal death rate in the United States and Texas is stag- gering, and it’s getting worse.
Pregnancy-related deaths in the United States per 100,000 live births* 7.2 1987 18.4 2007 15.5 2008 Pregnancy-related deaths in Texas per 100,000 live births† 30.7 2011
*Source: Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System
†Source: Department of State Health Services, March 2013 September 2013 TEXAS MEDICINE 55
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