Citation

Koch AR, Geller SE. Am. J. Obstet. Gynecol. 2017; 217(5): 556.e1-556.e6.

Affiliation

Departments of Obstetrics and Gynecology and Internal Medicine, College of Medicine, Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.ajog.2017.08.005

PMID

28844823

Abstract

Homicide, suicide, and substance abuse accounted for nearly one-fourth of all pregnancy-associated deaths in Illinois from 2002-2013. Maternal mortality review in Illinois has been primarily focused on obstetric and medical causes and little is known about the circumstances surrounding deaths due to homicide, suicide, and substance abuse, if they are pregnancy related, and if the deaths are potentially preventable. To address this issue we implemented a process to form a second statewide maternal mortality review committee for deaths due to violence (MMRC-V) in late 2014. We convened a stakeholder group to accomplish three tasks: 1) identify appropriate committee members for the MMRC-V; 2) identify potential types and sources of information that would be required for a meaningful review of violent maternal deaths; and, 3) revise the maternal mortality review form (MMRF). Because homicide, suicide, and substance abuse are closely linked to the social determinants of health, the review committee needed to have a broad membership with expertise in areas not required for obstetric maternal mortality review, including social service and community organizations. Identifying additional sources of information is critical; the state Violent Death Reporting System, case management data, and police and autopsy reports provide contextual information that cannot be found in medical records. The stakeholder group revised the MMRF to collect information relevant to violent maternal deaths, including screening history and psychosocial history. The form guides the MMRC-V to identify potentially preventable factors relating to the woman, her family, systems of care, the community, the legal system, and the institutional environment. The committee has identified potential opportunities to decrease preventable death requiring cooperation with social service agencies and the criminal justice system in addition to the physical and mental health care systems. Illinois has demonstrated that by engaging appropriate members and expanding the information used, it is possible to conduct meaningful reviews of these deaths and make recommendations to prevent future deaths.

Copyright © 2017 Elsevier Inc. All rights reserved.

Language: en

Keywords

maternal mortality review; pregnancy-associated homicide; pregnancy-associated substance abuse; pregnancy-associated suicide