Maternal Mortality And Morbidity Research Articles

Individual and community-level risk factors for maternal morbidity and mortality among Native American women in the USA: protocol for systematic review

IntroductionIncidents of maternal morbidity and mortality (MMM) continue to rise in the USA. Significant racial and ethnic health inequities exist, with Native American (NA) women being three to four times...

Public Priorities in Women's Health: Analysis of Request for Information Published to Inform "Advancing NIH Research on the Health of Women: A 2021 Conference".

Objectives: To assist with planning a congressionally requested conference on women's health research, the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) invited comments to characterize public concerns related to any or all of the specified public health issues: maternal morbidity and mortality (MMM); stagnant rates of cervical cancer survival; and the growing incidence of chronic debilitating conditions in women (CDCW). This analysis summarizes public priorities in women's health research. Materials and Methods: All comments received in response to a request for information were open coded and a master list of keywords was created, and comments were categorized. Comments addressing CDCW were categorized using a conceptual framework developed by the NIH. Results: Two hundred forty-seven comments were coded and analyzed. One hundred four comments (42%) addressed MMM; 182 comments (73%) discussed CDCW; and 27 comments (10%) addressed cervical cancer. Comments focused on CDCW most frequently addressed female-specific conditions (83%). The 10 most frequently identified keywords in order of frequency from the manual coding were as follows: (1) MMM, (2) racial disparities, (3) access to care, (4) provider training, (5) mental health, (6) Black or African American women, (7) screening, (8) quality of care, (9) time to diagnosis, and (10) social determinants of health. Conclusions: Comments demonstrate a broad range of concerns related to the health of women, including MMM, CDCW, and cervical cancer. A wide array of commenters included patients, advocacy groups, and academic and professional organizations originating from geographically diverse locations. These comments reflect a strong desire from the public to prioritize research on the health of women.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

The Potential for Health Information Technology Tools to Reduce Racial Disparities in Maternal Morbidity and Mortality.

Health information technology (health IT) potentially is a promising vital lever to address racial and ethnic, socioeconomic, and geographic disparities in maternal morbidity and mortality (MMM). This is especially relevant given that approximately 60% of maternal deaths are considered preventable.1–36 Interventions that leverage health IT tools to target the underlying drivers of disparities at the patient, clinician, and health care system levels potentially could reduce disparities in quality of care throughout the continuum (antepartum, intrapartum, and postpartum) of maternity care. This article presents an overview of the research (and gaps) on the potential of health IT tools to document SDoH and community-level geocoded data in EHR-based CDS systems, minimize implicit bias, and improve adherence to clinical guidelines and coordinated care to inform multilevel (patient, clinician, system) interventions throughout the continuum of maternity care for health disparity populations impacted by MMM. Telemedicine models for improving access in rural areas and new technologies for risk assessment and disease management (e.g., regarding preeclampsia) also are discussed.

Social accountability approaches employed by civil society organisations to address maternal mortality and morbidity in Uganda

ABSTRACT Despite ground breaking technological innovations, maternal mortality and morbidity (MMM) remains pervasive, especially in the least developed world. This article maintains that one way of empowering women to demand for an improvement in maternal health is through prioritising social accountability. It is forwarded that the implementation of social accountability mechanisms, substantially contributes to the reduction of preventable MMM in Uganda. Social accountability is a vibrant and dynamic process through which communities as well as civil society use various means to make public officials and other service providers more effective in the execution of their duties and obligations. Social accountability emphasises going beyond capacity building, which is often the focus of most community engagement strategies, to deliberately involving communities in tracking government programmes and adopting remedial mechanisms. The application of these processes helps to address gaps in the health system that lead to maternal deaths as well as morbidities. Using a documentary review approach, the paper identifies social accountability strategies that have been used by Civil Society Organisations (CSOs) in Uganda. This is aimed at highlighting how social accountability can be implemented to tackle maternal mortality and morbidity and ultimately improve sexual and reproductive health and rights.

Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin

BackgroundBehavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs.MethodsData from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models.ResultsMedian age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies.ConclusionOne FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.

The Intersection of Maternal Morbidity and Mortality and Intimate Partner Violence in the United States

Background: In the United States, rates of maternal morbidity and mortality (MMM) are high compared with other high-income countries and are characterized by significant racial/ethnic disparities. Typically, research on MMM focuses on obstetrical problems. Less research examines the role of intimate partner violence (IPV). Maternal health, IPV, and their intersection are linked with the impacts of social determinants of health. Objective: We sought to understand the intersection of MMM and IPV in the United States, particularly data issues that hinder research in this area and the resulting knowledge gaps. Methods: We identified major articles of interest regarding maternal morbidity and mortality and IPV in the United States and drafted a mini review based on relevant information. Results: Despite the prevalence of IPV during pregnancy, the intersection of maternal health and IPV has not been widely reviewed or discussed. Conclusion: There are a number of limitations in surveillance activities and data collection that underestimate the impact of IPV on MMM. Importantly, women who die by homicide or suicide— which in many cases is linked with IPV—are not counted as pregnancy-related deaths in the United States under the current definition. Establishing separate panels of local experts in maternal health or maternal mortality review committees (MMRCs) that are dedicated to examining violent deaths and use of the Maternal Mortality Review Information Application system would likely improve data accuracy of pregnancy-associated deaths. Based on the literature reviewed and limitations of current data, there are significant knowledge gaps on the effects of IPV and maternal health.

Using the Ecological Systems Theory to Understand Black/White Disparities in Maternal Morbidity and Mortality in the United States.

Maternal morbidity and mortality (MMM) is a significant problem in the USA, with about 700 maternal deaths every year and an estimated 50,000 "near misses." Disparities in MMM by race are marked; black women are disproportionately affected. We use Urie Bronfenbrenner's ecological systems theory to examine the root causes of racial disparities in MMM at the individual (microsystem), interpersonal (mesosystem), community (exosystem), and societal (macrosystem) levels of influence. This review discusses the interaction of these levels of influence on racial disparities related to MMM-covering preconception health, access to prenatal care, implicit bias among health care providers and its possible influence on obstetric care, "maternity care deserts," and the need for quality improvement among black-serving hospitals. Relevant policies-parental leave, Medicaid coverage during pregnancy, and Medicaid expansion-are considered. We also apply the ecological systems theory to identify interventions that would most likely reduce disparities in MMM by race, such as revising the educational curricula of health care professionals, enhancing utilization of alternate prenatal care providers, and reforming Medicaid policies.

Racial Disparities in Comorbidity and Severe Maternal Morbidity/Mortality in the United States: An Analysis of Temporal Trends

(Acta Obstet Gynecol Scand. 2018;97:89–96) In the United States, there has been a temporal increase in the incidence of severe maternal morbidity and mortality (MMM) over the past several years. In fact, between 1998 and 2009 severe maternal morbidity occurring during hospitalization for delivery increased by 75%. However, this increase has not been consistent across all racial groups. The current population-based study aimed to demonstrate the racial disparities in maternal comorbidities and severe maternal morbidity/mortality.

Racial Disparities in Comorbidity and Severe Maternal Morbidity/Mortality in the United States: An Analysis of Temporal Trends

(Acta Obstet Gynecol Scand. 2018;97:89–96) In the United States, there has been a temporal increase in the incidence of severe maternal morbidity and mortality (MMM) over the past several years. In fact, between 1998 and 2009 severe maternal morbidity occurring during hospitalization for delivery increased by 75%. However, this increase has not been consistent across all racial groups. The current population-based study aimed to demonstrate the racial disparities in maternal comorbidities and severe maternal morbidity/mortality.

POST PARTUM HEMORRHAGE;

Primary postpartum hemorrhagic, rightly called as obstetrician’s nightmare,refers to excessive blood loss of more than 500ml during the third stage of labour or in the first24 hours after delivery. It continues to be one of the leading causes of maternal mortality andmorbidity all over the world including Pakistan where it is responsible for 21-31% of maternalmortality and morbidity. Objectives: Objective of study was to determine the efficacy of balloontamponade in the management of primary PPH, so that a low cast, easy to use technology isavailable for conserving future fertility by treating postpartum hemorrhage. Settings: Departmentof Gynae &amp; Obs, Allied Hospital, Faisalabad. Study Design: Descriptive cross sectional study.Study Period: 6 months from 1st Oct, 2015 to 31st March, 2016. Material &amp; Methods: All patientsdelivered vaginally at term (after 37 completed weeks of gestation) who developed PPH due touterine atony after failure of conventional medical therapy were included in this study. Patientselection was based on inclusion and exclusion criteria. Their demographic profile and efficacyof balloon tamponade was checked in terms of time required to control hemorrahage andneed of laparotomy. Results: During study period total no. Of vaginal deliveries were 3000.Out of these 298 developed PPH, 220 had PPH due to uterine atony and did not respond toconventional medical therapy. The age of patients ranged between 22 and 40 years with meanage of 30 year (±4.88SD). The parity of the patients ranged between 1 and 14 with the meanparity of 4 (±2.26SD). The condom catheter was introduced in all the selected 80 patients andwas successful in 73 patients. Conclusions: In developing countries such as Pakistan wherethe maternal death rate from PPH is very high, this safe, in expensive and easy procedure (itdoes not require any expertise) can be applied in any situation to save a life and to save theuterus in young patients to conserve reproductive capacity and prevent them from surgery andits morbidity. This will protect the patients from irreversible shock and even death with a successrate of 85-95%.

ECLAMPTIC PATIENTS

Background: Hypertensive disorders are the second most common cause ofmaternal death worldwide. Eclampsia is the extension of pregnancy induced hypertension tothe point of conclusions, coma or both. Objectives: To find out the incidence of eclampsiaamong pregnant women and to identify the maternal and perinatal outcomes of eclampticpatients treated in a tertiary care referral hospital. Study Design: Discretional cross sectionalstudy. Setting: Department of Obstetrics &amp; Gynecology, Sheikh Zayed Hospital, Rahim YarKhan. Period: January 2014 to December 2014. Methods: A total number of 96 patients out of10513 who were diagnosed as being eclamptic during the study period were included in thisstudy. While normal pregnant women and Patient’s with uncertain diagnosis was excluded. Allpatient variables were entered and analyzed using SPSS v20. Frequency and percentages wereused to express qualitative variables. Results: There were total ninety six patients (0.913%) outof 10,513 who presented with eclampsia. Most of eclamptic patients were of having age &gt;21years. Among patients who developed eclampsia 52 (54.16%) were in Ante partum period and40 (41.66%) were in postpartum period. Out of 96, five patients died before delivery and thirteenafter delivery, seventy eight patients developed one or more complications during delivery.Out of total 91 deliveries, 54 (59.30%) were delivered by cesarean section (C/S). Main reasonfor C/S was unfavorable cervix. Out of total ninety one deliveries two were twins and eightynine singletons. Fifty eight (62.36%) babies were born at a gestational age &lt;37 weeks. Birthasphyxia occurred in sixty one (65.60%) newborns. There were twenty two (23.65%) perinataldeaths, fourteen (63.64%) were stillbirths and eight (36.36%) were early neonatal deaths.Conclusion: Eclampsia is found to be associated with very high rates of maternal mortality andmorbidity as well as perinatal mortality. Early diagnosis of eclampsia and its timely managementcan reduce the risk of this mortality. This can be made possible by provision of basic facilitiesand improvements in the quality of basic care provided by our antenatal clinics.

MATERNAL COMPLICATIONS OF SEVERE PRE-ECLAMPSIA AND ECLAMPSIA

BACK GROUND: Preeclampsia (PE) and eclampsia have been matters of serious medical concernsassociated with pregnancy. About 5 to 10% of pregnancies are associated with hypertensive disorders.These include gestational hypertension, preeclampsia (PE), chronic hypertension and preeclampsiasuperimposed on chronic hypertension. Preeclampsia can lead to substantial maternal and fetalmorbidity and mortality.OBJECTIVE: The aim of present study is to determine the maternal complications of severepreeclampsia and eclampsia.MATERIALS AND METHODS: This Retrospective Study was carried out at the Department ofGynecology and Obstetrics, Lady Reading Hospital, Peshawar and Department of Biochemistry, KhyberMedical College, Peshawar, Khyber Pakhtunkhwa during May, 2013 and April, 2014 on 156 femalepatients with history of preeclampsia and eclampsiameeting predetermined selected criteria.RESULTS: Out of 156 patients with preeclampsia and eclampsia, 94 cases(60.30%) were in the agegroup of 20-30 years. Primigravida were 43.60%(n=68 cases) while multigravidas were 41.70%(n=65cases). Delivery route was mainly vaginal in 127 cases(80%). The most frequent maternal complicationwas HELLP syndrome in 7.10%(n=l leases), visual disturbances in 7.70%(n=12cases), hepaticcomplications in 4.50%(n=7cases),DIC in 3.80%(n=6cases), renal impairment in 3.20%(n=5cases),aspiration pneumonia in 2.60%(n=4cases) and maternal mortality in 9.60%(n=15 cases).CONCLUSION:Pre-eclampsia and eclampsiaare associated with increase in maternal morbidity andmortality. Complications can be prevented by proper antenatal checkups, increasing literacy rate,creating awareness regarding health education and early diagnosis and referral to tertiary level hospitals.Key Words: Pre-eclampsia, Eclampsia, Maternal Complications,HELLP syndrome.