title: A review of the preventability of maternal mortality in one hospital system in Louisiana, USA.
abstract: OBJECTIVE
  To determine preventability of in-hospital maternal mortality in the Ochsner Health System (OHS) in the US state of Louisiana.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Morong
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.|Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA, USA.
authors.forename: Jane K
authors.initials: JK
authors.lastname: Martin
authors.affiliation: Child Health Research Centre, The University of Queensland School of Medicine, Brisbane, Qld, Australia.|Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.|Department of Maternal Fetal Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
authors.forename: Alfred G
authors.initials: AG
authors.lastname: Robichaux
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage; D008145:Louisiana; D063130:Maternal Death / Q000517:prevention & control*; D008428:Maternal Mortality / Q000639:trends*; D008484:Medicaid; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Death; Louisiana; Maternal mortality; Maternal mortality ratio; Preventability; USA