OBJECTIVE: To improve ascertainment of pregnancy-related deaths, the Centers for Disease Control and Prevention has encouraged states to utilize electronic linkage of death certificates with fields that identify the mother on live birth and fetal death certificates within the year preceding the death. The objective of this study was to estimate the completeness of case ascertainment when this enhanced surveillance (ES) is combined with the traditional method of identifying pregnancy-related codes from death certificates alone (DC). STUDY DESIGN: This is a population-based study from North Carolina that utilizes capture-recapture epidemiological methods. For the three-year study period, 1994-1996, those deaths that were pregnancy-related and occurred within one year of delivery were coded as being ascertained through ES, DC, or both. RESULTS: Of 79 pregnancy-related deaths, 49 (U) were identified by both DC and ES, 6 (V) by DC alone, and 24 (W) by ES alone. From Wittes, the nearly unbiased estimator for calculating the total number of pregnancy-related deaths is: N={[(U+V+1) (U+W+1)] /(U+1)} - 1=81.9 Completeness of case ascertainment with DC alone=54 / 81.9 or 66% but with DC + ES=79 / 81.9 or 96%. CONCLUSIONS: Ascertainment is a primary determinant of rates, the hallmark of epidemiology. The addition of ES to DC results in greater than 95% ascertainment of all pregnancy-related deaths for a population.
Learning Objectives: 1. Recognize the problems of ascertainment of maternal deaths and the under-reporting of maternal mortality ratios. 2. List methods for ascertaining maternal deaths. 3. Assess the completeness of case ascertainment using capture-recapture epidemiologic methods
Keywords: Mortality, Pregnancy
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.