Louisiana Pregnancy-Associated Mortality Review (LaPAMR)
Despite the marked decline in maternal mortality in the United States over the past century, reduction in mortality over the past several decades has remained limited. The aggregate rates of pregnancy-associated death remain unacceptably high, and both geographic and racial/ethnic disparities are alarming. Through public health surveillance from 2003-2007 Louisiana has been identified as having one of the highest maternal mortality rates in the United States.
In 1992, the Louisiana Pregnancy Mortality Surveillance System (LPMSS) was initiated by the Louisiana Department of Health and Hospitals (DHH) Office of Public Health (OPH) State Center for Health Statistics (SCHS) with the purpose of identifying women who died during or within ninety days of pregnancy. Cases were identified by the death certificate check box labeled "If deceased was female 10-49, was she pregnant in the last 90 days?" The Centers for Disease Control and Prevention (CDC) Division of Reproductive Health for pregnancy mortality surveillance was initiated in 1987 and in 2006 teamed with the Louisiana Center for Health Statistics and Vital Records to better identify maternal deaths. Data requested by the CDC included 2004 death certificates for all women who died during pregnancy (ICD-10 chapter O) or within one year of pregnancy, regardless of the cause of death, and the birth or fetal death certificates associated with said women.
In 2000, the Louisiana DHH-OPH Maternal and Child Health (MCH) Program reviewed all pregnancy mortality from 1995 to 1999. After 2000, pregnancy mortality was reviewed annually using only maternal death certificates and associated birth or fetal death certificates provided by the OPH SCHS Records through the LPMSS.
In 2007, the Louisiana MCH Program conducted a 2000-2005 pregnancy mortality evaluation using data provided by the Center for Health Statistics and Vital Records through LPMSS and maternal death and birth or fetal death linked data. The purpose of the study was to determine if the use of enhanced linkage procedures improved data collection of pregnancy deaths and how maternal deaths vary by different definitions. Several recommendations resulted from the study including the need to improve the methodology and procedure of pregnancy mortality review in the state of Louisiana.
In 2010, the MCH Program initiated the Louisiana Pregnancy Associated Mortality Review (LA-PAMR) under the authorization of the Louisiana Perinatal Commission. PAMR reviewed 2008 pregnancy-associated deaths using data provided through the LPMSS and by linking maternal death certificates and Louisiana Hospital Inpatient Discharge (LAHIDD) records with birth and fetal death certificates. In addition to the aforementioned formal database sources, clinical data were abstracted from hospital records, prenatal care records, and autopsy reports to form a comprehensive review. Consistent with ACOG/CDC definitions, all deaths that occurred during or within one year of pregnancy, regardless of the cause of death, were reviewed. In 2012, the MCH Program completed the first Louisiana PAMR report.
This comprehensive framework for surveillance and individual case review where all available clinical information for each death is evaluated is based on methodology modeled by the CDC Pregnancy Mortality Surveillance System. Instead of classifying cause of death solely based on ICD codes, this format of structured review allows for classification based on temporal and causal relationships between clinical factors associated with the pregnancy and death.