Maternal Mortality In The USA Research Articles

Black/African American Women's Woes: Women's Perspectives of Black/African American Maternal Mortality in the USA.

Despite advances in perinatal care in the USA, maternal mortality is on the rise, and maternal death is higher than in any other high-income country. Maternal mortality in the USA is a persistent public health concern. This issue disproportionately affects Black/African American women, with their likelihood of pregnancy-related death being three times more likely compared to White women. This study aimed to explore the resources needed for Black/African American women to address the relatively higher maternal mortality rates recorded for them. An anonymous link with demographic and open-ended questions was sent to US women 18 years and older to participate in the study. A total of 140 participants responded to the survey. We retained a final sample of 118 responses after eliminating responses with missing data. Descriptive statistics are reported for closed-ended items. Open-ended responses were analyzed using content analysis procedures, where we coded and categorized the data into themes. Six themes were identified from the study data: (1) Diversity, Equity, and Inclusion (DEI) training for health providers focused on racial bias and discrimination, (2) Advocacy, (3) Provider selection, (4) Researching doctors and delivery hospitals to inform women's birthing decision-making, (5) Women's care-seeking behaviors, and (6) Addressing the Social Determinants of Health. Based on the study's findings, we recommend DEI training for healthcare professionals providing direct care to pregnant and postpartum women, advocacy and resource-awareness training for pregnant Black/African American women and their spouses/partners, or a family member, to assist them in their pregnancy and birthing journeys.

Cardio-Obstetrics: A Focused Review.

Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.

Maternal Mortality in the USA

Maternal Mortality in the USA

Insights from outside BJOG

Insights from outside BJOG

Point-of-Care Thromboelastometry in the Management of Acute Obstetric Hemorrhage

Massive obstetric hemorrhage is the leading cause of maternal morbidity and direct obstetric death in developed countries. It is also the most frequent reason for maternal ICU admission. Mismanagement of maternal hemorrhage is one of the potentially preventable causes of maternal mortality in the USA. Thromboelastometry (TEM)—previously named rotational thromboelastography (ROTEG) or rotational thromboelastometry (ROTEM)—is an established viscoelastic method for hemostasis testing in whole blood. It investigates the interaction of coagulation factors, their inhibitors, anticoagulant drugs, and blood cells (especially platelets) during clotting and subsequent fibrinolysis. The rotational conditions mimic the sluggish flow of blood in veins. Introduction into clinical practice of point-of-care TEM provides prompt bedside analysis of hemostasis. Utilization of point-of-care TEM allows for the transition from one-size-fits-all fixed-ratio resuscitation to a personalized goal-directed transfusion strategy. Such an individualization of treatment for hemorrhage-related coagulopathy will almost certainly lead to improvements in clinical outcome and a reduced cost of care for patients with massive obstetric hemorrhage.

Incidence and causes of maternal mortality in the USA.

To characterize the most common causes and risk factors of maternal mortality in the USA and observe trends over the past 9 years. We carried out a population-based retrospective cohort study using data from the Health Care Cost and Utilization Project, Nationwide Inpatient Sample. Women who were pregnant between 2003 and 2011 were identified. Baseline characteristics of pregnant women who died and those who lived were measured. ICD-9 codes for each cause of death were examined by up to three independent reviewers. Causes of death were categorized into the nine most common subgroups and trends were examined by tertiles of the period 2003-2011. During this 9-year period, there were approximately 7 million births and 1102 maternal deaths, for an overall incidence of 14.2 per 100 000 births. Primary causes of maternal death included sepsis (20.6%), cardiac disease (17.8%), hemorrhage (16.2%), venous thromboembolism (15.2%), and hypertensive disorders (9.4%). During the study period, there was a significant decrease in the frequency of sepsis from 33.2% to 10.0% and a non-significant decrease in venous thromboembolism from 19.1% to 12.9%. There were increases noted in all other groups, notably in terms of hemorrhage from 8.2% to 22.0% and hypertensive disorders from 2.1% to 16.4%. Maternal mortality remains a rare event. Although sepsis was the overall predominant cause of mortality during the study period, frequency declined over time and it was surpassed by hemorrhage and hypertensive disorders as the leading causes of maternal mortality.

Management of hypertensive disorders in pregnancy.

Hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5-10%, and a common cause of maternal mortality in the USA. Incidence of pre-eclampsia has increased by 25% in the past two decades. In addition to being among the lethal triad, there are likely up to 100 other women who experience 'near miss' significant maternal morbidity that stops short of death for every pre-eclampsia-related mortality. The purpose of this review is to present the new task force statement and novel definitions, as well as management approaches to each of the hypertensive disorders in pregnancy. The increased understanding of the pathophysiology of hypertension in pregnancy, as well as advances in medical therapy to minimize risks of fetal toxicity and teratogenicity, will improve our ability to prevent and treat hypertension in pregnancy. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations.

Is vaginal delivery or caesarean section the safer mode of delivery in patients with adult congenital heart disease?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is vaginal delivery or caesarean section (CS) the safer mode of delivery in patients with adult congenital heart disease? Of the 119 studies, 13 papers represented the best evidence on the topic. Recommendations are based on 29 262 patients. Those having undergone successful corrective or palliative cardiac surgery for congenital heart disease, in addition to patients with unoperated congenital heart disease are a high-risk obstetric population. Heart disease is a leading cause of maternal mortality in the USA and the UK. Traditionally, CS was regarded as the mode of delivery of choice for high-risk patients, but growing experience in this field has now made this advice appear controversial. Patients are stratified into high- and low-risk, depending on the degree of heart failure symptoms [New York Heart Association (NYHA) class]. All studies demonstrated adverse outcomes in ACHD patients compared with normal age-matched controls. This pertained to a higher overall risk of maternal cardiac death, neonatal death, preterm birth, fetal growth restriction and longer hospital stay. On univariate regression analysis, the variables that imparted the highest risk to mother and foetus, were right ventricular failure, pulmonary regurgitation and pulmonary hypertension (P < 0.001). Induction of labour was deemed safe and was not associated with higher CS rates. There was no increase in maternal or neonatal complications in patients who were NYHA class I and II at labour. Patients who were NYHA class III and IV at labour had higher complication rates with adverse feto-maternal outcomes (P < 0.0001) and longer intensive care unit and hospital stay (Spearman's correlation 0.326, P = 0.007). The largest cohort from the USA (26 973 ACHD births) demonstrated that ventricular septal defect was associated with the highest risk of maternal death and complications (P < 0.05). The data would indicate that patients NYHA class I and II symptoms are suitable for VD. For most NYHA III and IV patients a trail of labour is safe with expedited delivery under good analgesic control as dictated by obstetric needs. Due to high complication risks, CS may be indicated in a proportion of patients.

Incidence, risk factors and outcome of venous thromboembolism in critically ill obstetric patients

Venous thromboembolism (VTE) during pregnancy remains a significant cause of obstetric morbidity and mortality, presenting the leading cause of maternal mortality in the USA and Europe. In the present study we tried to determine the prevalence of VTE, risk factors and mortality associated with VTE in critically ill obstetric patients.

Blood pressure monitoring during pregnancy.

Hypertensive disease in pregnancy represents a significant health problem in the world, and ranks second only to thromboembolism as a cause of maternal mortality in the USA. In addition, hypertension is associated with both perinatal morbidity and mortality secondary to direct effects on the fetus as well as the iatrogenic preterm deliveries performed for maternal indications. Conventional (office, mercury column or aneroid manometry) blood pressure measurement is the most common screening test performed during prenatal visits. During the past several years, investigators have focused on the use of 24-h ambulatory and automated self (or home) blood pressure monitoring during pregnancy. This review article summarizes the current literature on both ambulatory and home blood pressure monitoring in pregnancy and how they relate to various clinical aspects of hypertension in pregnancy.