Page 20 - Layout 1

MATERNAL
MORTALITY

Maternal Mortality

in Bexar County:

How are we

addressing the issue?

By Dr. Margaret Kelley

2017, the Texas Maternal Mortality and Morbidity Morbidity Task Force will not release locally specific data or findings
In Task Force and Department of State Health Services to the local health departments. Therefore, the Metro Health De-
released its 2016 Biennial Report. The calendar year
partment, without doing its own study, is not able to specifically re-
of 2011 -2012 was studied. There were 189 maternal late maternal morbidity and mortality outcomes for Bexar County.
deaths that year. Any woman who died 365 days from a birth was This data is needed to improve a community network of stakehold-
included in the analysis. The leading causes of maternal death were ers to systematically lower maternal morbidity and mortality in
cardiac events, drug overdose, and hypertension/pre-eclampsia, Bexar County.
hemorrhage, sepsis, homicide and suicide. Black women had the The MMMR is composed of a wide range of community leaders
highest rates of maternal death. While black women compose 11.4 who encounter an obstetrical patient, including obstetricians, in-
percent of all births in Texas, they comprised 28.8 percent of ma- ternists, nurses, pediatricians, a pathologist, and epidemiologists.
ternal deaths. Hispanic women had lower death rates compared to There will be three subcommittees: Data
total percentage of births. High deaths from drug overdoses, mainly Collection, Case Review and Community Action. Data collection
opiates, were a surprise finding of the study. A profound finding of pregnancy related deaths remains very challenging. Information
of the Task Force was that there were 16.9 per 1,000 obstetrical on death certificates can be inaccurate. Therefore, it is necessary to
hospitalizations related to hemorrhage and transfusion. Given these verify a pregnancy and to ask “if the patient had not been pregnant
findings the questions arise as to what are our maternal mortality would the patient have died.” Thereafter, it will be necessary to de-
statistics in Bexar County and what can be done to lower maternal termine if the pregnancy-related death was “complication of preg-
morbidity and mortality? In this light, in 2017 the Bexar County nancy itself, a cascade of events initiated by pregnancy, or the
Maternal Mortality and Morbidity Review Task Force (MMMR) was aggravation of an unrelated condition or event by the physiologic
established. effects of pregnancy.” Moreover, the Case Review subcommittee
The Bexar County Maternal Mortality and Morbidity Task Force with help identify pregnancy-related deaths and analyze and inter-
was established with funding from the Metro Health Healthy Start pret the findings. Finally, the Community Action subcommittee will
Grant. The objective of the MMMR is to “improve maternal and be tasked to partner with local organizations to further make rec-
perinatal outcomes by adopting and applying locally relevant strate- ommendations to improve obstetrical outcomes.
gies and interventions to prevent future deaths. Furthermore, the While the recent news of maternal morbidity and mortality is
MMMR will prioritize critical health services, and community re- sobering, one can reflect on history to have hope that improved ob-
sources to address the unmet health needs for black women who stetrical outcomes are possible. In 1846, Dr. Igaz Semmelweis was
are three to four times more likely to die from pregnancy-related appalled by the high rates of maternal deaths from “puerperal
complications than white women.” fever,” at the General Hospital in Vienna. He systematically inves-
One may ask why does Bexar County need its own MMMR? One tigated this issue and discovered that women cared for by the physi-
reason is to look specifically at our local data. The State Maternal cians and medical students had higher death rates than those cared

20 San Antonio Medicine • July 2018