Assigning cause of maternal death: a comparison of findings by a facility‐based review team, an expert panel using the new ICD‐MM cause classification and a computer‐based program (InterVA‐4)

Abstract

ObjectiveTo compare methodology used to assign cause of and factors contributing to maternal death.DesignReproductive Age Mortality Study.SettingMalawi.PopulationMaternal deaths among women of reproductive age.MethodsWe compared cause of death as assigned by a facility‐based maternal death review team, an expert panel using the International Classification of Disease, 10th revision (ICD‐10) cause classification for deaths during pregnancy, childbirth and the puerperium (ICD‐MM) and a computer‐based probabilistic program (Inter VA‐4).Main outcome measuresNumber and cause of maternal deaths.ResultsThe majority of maternal deaths occurred at a health facility (94/151; 62.3%). The estimated maternal mortality ratio was 363 per 100 000 live births (95% CI 307–425). There was poor agreement between cause of death assigned by a facility‐based maternal death review team and an expert panel (κ = 0.37, 86 maternal deaths). The review team considered 36% of maternal deaths to be indirect and caused by non‐obstetric complications (ICD‐MM Group 7) whereas the expert panel considered only 17.4% to be indirect maternal deaths with 33.7% due to obstetric haemorrhage (ICD‐MM Group 3). The review team incorrectly assigned a contributing condition rather than cause of death in up to 15.1% of cases. Agreement between the expert panel and Inter VA‐4 regarding cause of death was good (κ = 0.66, 151 maternal deaths). However, contributing conditions are not identified by Inter VA‐4.ConclusionsTraining in the use of ICD‐MM is needed for healthcare providers conducting maternal death reviews to be able to correctly assign underlying cause of death and contributing factors. Such information can help to identify what improvements in quality of care are needed.Tweetable abstractFor maternal deaths assigning cause of death is best done by an expert panel and helps to identify where quality of care needs to be improved.

Causes of maternal deaths and delays in care: Comparison between routine Maternal Death Surveillance and Response system and an obstetrician expert panel in Tanzania

“…Overall there was substantial agreement in categorizing the underlying cause of death and the ICD-MM group of causes with high K statistic of 0.76. This is in contrast with other studies in Sub Saharan Africa and the US, that have shown signi cant differences when researcher-assigned causes of death were compared with health care providers' (23)(24)(25)(26). The substantial agreement in our study could be due to the national training of the MDSR committees on the use an ICD10 shortlist and orientation on ICD 10 codes.…”

A prospective cause of death classification system for maternal deaths in low and middle‐income countries: results from the Global Network Maternal Newborn Health Registry

“…To improve consistency, inter‐observer agreement and comparability, we developed an algorithm based on the International Classification of Disease—Maternal Mortality (ICD‐MM) system, to assign COD. In this system, the causes include trauma, termination of pregnancy‐related mortality, pre‐eclampsia/eclampsia, haemorrhage, pregnancy‐related infection and medical conditions not associated with pregnancy . The purpose was to determine maternal COD within the Maternal Newborn Health (MNH) Registry, a population‐based cohort of pregnant women of the National Institute of Child Health and Human Development (NICHD)'s Global Network for Women's and Children's Health Research (Global Network).…”

The Reliability of Maternal Audit Instruments to Assign Cause of Death in Maternal Deaths Review Process: A Systematic Review and Meta-Analysis

“…The agreement between the expert panel using ICD-MM and probabilistic model of INTERVA-4 was substantial (κ = 0.66, 151 maternal deaths). However, INTERVA-4 did not identify the contributing factors of maternal mortality (25).…”

“…The study of Owolabi in 2014 and Mgwadere in 2016 reported there was fair agreement between the facility-based review team and an expert panel using the ICD-MM classi cation (κ = 0.219, 53 maternal deaths and κ = 0.37, 86 maternal deaths, respectively). Because of the diverse variability of contributing factors, the levels of agreement among the groups cannot be accurately calculated (24,25). There were two studies which applied verbal autopsy (VA) using electronic instruments, known as INTERVA-M and INTERVA-4 (20,25).…”

“…Because of the diverse variability of contributing factors, the levels of agreement among the groups cannot be accurately calculated (24,25). There were two studies which applied verbal autopsy (VA) using electronic instruments, known as INTERVA-M and INTERVA-4 (20,25). In one study, the VA electronic instrument of INTERVA-4 was assessed as a comparator instrument to assign cause of maternal death using ICD-MM for healthcare providers in facility-based MDR.…”