A review of the preventability of maternal mortality in one hospital system in Louisiana, USA

James J. Morong, Jane K. Martin, Robert S. Ware, Alfred G. Robichaux

To determine preventability of in-hospital maternal mortality in the Ochsner Health System (OHS) in the US state of Louisiana. A retrospective study was undertaken of all known cases of in-hospital maternal death (during pregnancy or within 42 days of termination) that occurred within OHS facilities in 1995-2013. Associations between characteristics and mortality and preventability were investigated. Incidence rate ratios (IRRs) were calculated in view of varying reference values. Among 16 eligible deaths, 12 (75%) were deemed potentially preventable. The incidences of overall and preventable maternal death were higher if the patient had late entry to prenatal care (IRR 6.3 [P=0.004] and 8.8 [P=0.004], respectively). Maternal mortality was increased if the patient had required transfer to the OHS (IRR 15.8 [P<0.001] overall and 15.8 [P=0.002] for preventable mortality). Deaths of patients with private insurance were more likely to be not preventable than were those of patients without such insurance (P=0.003). Uninsured patients had the highest MMR, with an IRR of 13.8 (P=0.014) when compared with Medicaid patients. The factors most predictive of mortality were late entry to prenatal care, critical status requiring transfer from an outside facility, and non-private insurance status.