In Reply: Dr. Weiss criticizes us for minimizing the importance of MVT as a cause of pregnancy-associated mortality by failing to detect a large proportion of MVT deaths in our case identification as well as for "selective referencing." Both criticisms lack merit.
As we point out in our article, we may not have identified some deaths that occurred during early pregnancy if an autopsy was not performed. However, Maryland law mandates that the medical examiner investigates all deaths that occur by violence, suicide, injury, unexpectedly, or in any suspicious or unusual manner, all MVT deaths are investigated by the medical examiner. Although an autopsy is not performed in all cases of MVT death, the medical examiner notes and police records are often available for review even if an autopsy was not performed. If pregnancy was noted in such records in our review of medical examiner data, the death was included in our study.
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