Cardiovascular
Violence
Of the 16 individuals
whose deaths were
reviewed between
2017-2018, 12 (75%)
had lived in rural
communities.
Of the 16 individuals whose deaths
were between 2017-2018, 12 (75%)
had lived in rural communities.
Social
Determinants
of Health
Infection
Substance
Misuse
and Mental
Health
Preventing Maternal Death
2020 Recommendations from the Alaska Maternal
Child Death Review Committee (MCDR)
The MCDR
committee
reviewed all Alaska
maternal deaths
(16) that occurred in
2017 and 2018. MCDR
denes a maternal death as
any death within one year of
pregnancy due to any cause.
Pregnancy places unique stress on the cardiovascular system and early
symptoms of disease can be subtle. A high index of suspicion is critical to patient
safety. Nationally, pre-eclampsia/eclampsia, stroke, myocardial infarction, and
cardiomyopathy, remain the leading contributors of maternal mortality. Signs
of disease include extreme swelling or weight gain, extreme fatigue, fainting,
persistent cough, chest pain or fast heartbeat and severe shortness of breath
(especially when lying down).
Pregnant and postpartum patients are
particularly susceptible to infection. Early recognition
and treatment are key to prevent progression to
sepsis and septic shock.
There is a need to recognize violence as a preventable public
health problem while increasing community and provider
education regarding the impact of violence as a prenatal
stressor.
There are a disproportionate number
of maternal deaths for residents living in rural
communities.
An increasing number of maternal deaths are related to substance
use and mental health conditions. There is correlation¹ between
substance abuse and higher rates of depression for individuals who
experience domestic violence. Between 2014 and 2018, alcohol
or substance use contributed to 63% of maternal deaths in Alaska
while mental health conditions contributed to 31%.
16 out of 16 (100%) maternal deaths were preventable
1) 4ps plus Screening Instrument, Depression and domestic violence; https://www.ntiupstream.com/4psabout/
Causes for Alaskan maternal deaths include:
* Yupik Translation Courtesy: Bristol Bay Elder, Mrs. Molly Chythlook
Each maternal death is
one too many.
"Atauciungermi yuunrilria
irnirraarluni qununarquq"*
Yupik Translation
Improve Training
• Support the goal for all obstetric care locations to participate in the Alliance for
Innovation on Maternal Health: the current AIM addresses recognition and
treatment of hypertension
• Follow CDC and ACOG perinatal and postnatal infection guidelines for
testing and screening of pregnant women
• Institute integrated behavioral health, with a validated universal prenatal
screening tool
• Provide referral and a warm hand off to appropriate therapy or bridge
clinic for patients positively screened for mental health issues, DV/IPV, or
illicit drug use
• Distribute Narcan kits with all opioid prescriptions and follow CDC opioid
prescription guidelines
• Offer all patients a referral for behavioral health counselling when prescribing an
antidepressant
• Promote and train all healthcare providers in Implicit Bias Training, Trauma
Informed Care and Adverse childhood experiences (ACEs)
• Support the goal for all obstetric care providers to have Medication Assisted
Treatment Waiver training
• Promote and train in cardiovascular conditions including the development of
a comprehensive interpregnancy care plan for individuals with heart disease and
patient education for signs/symptoms
• Ensure all providers receive training in Integrated Behavioral Health utilizing evidence-
based models
MCDR Program, Division of Public Health | 3601 C Street, Suite 358| Anchorage, AK 99503 |Email: [email protected]
ASHNHA: Anchorage | 1049 W 5th Avenue, Ste 100, Anchorage, AK, 99501 P: 907.646.1444
ASHNHA: Juneau | 426 Main Street, Juneau, AK, 99801 P: 907.586.1790 www.ashnha.com
“There is no power
for change
greater than
a community
discovering what
it cares about.
-Margaret Wheatley
MCDR committee recommendations to
help prevent future maternal deaths:
Improve policies
regarding prevention
initiatives including
screening procedures
and substance
use prevention &
treatment
MCDR 2017-2019 committee recommendations. We would like to sincerely thank Dr. Leanne K. Komorowski, M.D. &
LCDR Karla Weise RN, MPH for their assistance and advisement with MCDR recommendations and materials.