Pregnancy-related Deaths Research Articles

Cardiac disease and risk of hypertensive disorders of pregnancy

Cardiovascular disease affects 1-4% of US pregnancies and is the leading cause of pregnancy related deaths. There are limited data on rates of hypertensive disorders of pregnancy (HDP) in this population. ACOG and USPSTF guidelines for aspirin (ASA) use for reduction of preeclampsia (PEC) do not include cardiac disease in the high or moderate risk categories. Our objective was to determine if cardiovascular disease is a risk factor for developing HDP. This was a retrospective cohort study of pregnancies complicated by maternal cardiac disease at a single academic center between 2018 and 2022. Patients with cardiac disease (congenital or acquired) who delivered after 20 weeks were included. For patients with multiple pregnancies during the timeframe, only the first pregnancy was included. Patient demographics and pregnancy outcomes were recorded. The primary outcome was development of HDP. Secondary outcomes were correlation of HDP with presence of one high or two moderate risk factors based on ACOG guidelines for ASA use and severity of cardiac disease based on modified World Health Organization (mWHO) risk class. 115 patients were included. Demographic and outcomes are shown in Table 1. 18 (15.7%) patients developed HDP and 71 patients (61.7%) were on ASA. Among the 18 patients with HDP, 55% developed PEC with severe features and 44% developed PEC post-partum. HDP was associated with multiple gestations (p< 0.01), age (p=0.04) and the combination of one high risk or two moderate risk factors for PEC (p=0.03). mWHO class was not associated with development of HDP (p=0.86). It has not been established if cardiac disease in pregnancy is an independent risk factor for developing PEC. Our study reveals high rates of HDP in this cohort (15.7% in our population compared to CDC rate of 4% of US pregnancies), even in the setting of ASA use and regardless of mWHO risk class. While more research is needed, based on our data it would be reasonable to offer patients with cardiac disease ASA for prevention of PEC.

Maternal mortality by suicide in Morocco: prevalence and characteristics (study from 2003 to 2013)

Introduction: the reduction of maternal deaths is highly valued by the global society. In Morocco, there isn't yet a suicide registry. This study was out to identify the characteristics of pregnancy-related deaths of Moroccan expectant mothers, determine the prevalence of perinatal suicide, and evaluate its risk factors.

Assessment risk factors for women with ectopic pregnancy in Al-Zashraa teaching hospital at Al-Najaf city

Ectopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy, accounting for approximately 10% of all pregnancy-related deaths. It remains to be a condition presenting as a serious health problem for women of childbearing age. It has been shown to reduce subsequent fertility and increase the chances of subsequent EP. Over recent decades, there has been a rise in the incidence of EP. There is extensive literature regarding the potential risk factors for EP. The identified risk factors for EP include age, previous EP, previous pelvic surgery, use of intrauterine devices (IUDs), female sterilization, history of pelvic inflammatory disease, history of infertility and smoking at the time of conception. Methodology: A descriptive cross sectional study was adopted in order to achieve the stated objectives. The study began from 2 November 2021 to 24 April 2022. A non-probability sampling technique (purposive sample) based on the criteria of patient with only women with ectopic pregnancy sample of (48) woman who admitted who were selected from Al Zahra Teaching Hospital. Results: The study show the previous abortion was risk factors of ectopic pregnancy which there was high significant association. Recommends: The study recommends Educational health programs for women regarding risk factors of ectopic pregnancy.

Cardiovascular Risk Assessment as a Quality Measure in the Pregnancy and Postpartum Period

BackgroundCardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for over one-third of all pregnancy-related deaths. Contributing factors such as lack of recognition and delayed diagnosis of CVD are primarily due to the overlap of signs and symptoms of a normal pregnancy with those of CVD. ObjectivesThis study aimed to demonstrate the feasibility of introducing CVD risk assessment into clinical practice using the California Maternal Quality Care Collaborative algorithm to detect CVD during pregnancy and postpartum periods. MethodsWe implemented the CVD risk assessment algorithm into electronic health records at 3 large hospital networks serving over 14,000 patients at 23 sites. We determined the percentage of pregnant and/or postpartum patients who were screened for CVD risk and the follow-up rate for patients in whom the tool recommended a follow-up assessment. Rates were stratified according to clinical site characteristics. We obtained clinician feedback regarding the feasibility and acceptability of the tool. ResultsThe rate of patients screened for CVD risk in the 3 hospital networks was 57.1%, 71.5%, and 98.7%. For those with a positive screen, follow-up rates were 65.8%, 72.5%, and 55.9% in the 3 networks. The rates of screening and follow-up varied based on the clinic size and specialty. Clinician-identified barriers were busy clinics, competing priorities, and the type of clinical practice. ConclusionsThis innovative population-based approach for universal CVD risk assessment during pregnancy is feasible and may be a helpful strategy to decrease CVD-related maternal morbidity and mortality.

The “Family Health = Family Wealth” intervention: study protocol for a pilot quasi-experimental controlled trial of a multi-level, community-based family planning intervention for couples in rural Uganda

BackgroundUganda has one of the highest fertility rates globally, but only 30% of women report using an effective method of contraception. Community-based, multi-level interventions are needed to help couples in rural Uganda overcome barriers to contraceptive use.MethodsThis study will pilot test the Family Health = Family Wealth intervention, a multi-level, community-based intervention employing transformative community dialogues, which use facilitated discussion to reshape community norms that influence family planning acceptance, to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4 sessions (two gender-segregated and two gender-mixed). Sessions simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. At the health system level, a refresher training will be conducted with health workers in the intervention community’s health center to address gaps in contraceptive knowledge and skills as identified from a needs assessment.The intervention will be evaluated through a pilot quasi-experimental trial paired with a mixed methods process evaluation. Participants include 70 couples (N=140) randomized by community to the Family Health = Family Wealth intervention (n=35 couples) or to an attention-matched water, sanitation, and hygiene (WASH) intervention (n=35 couples). Participants include sexually active, married couples who are age 18 (or an emancipated minor) to 40 for women and age 18 (or an emancipated minor) to 50 for men, not pregnant, at least one person in the couple reports wanting to avoid pregnancy for at least a year, and not currently using a method of contraception or using a low-efficacy or ineffective method of contraception. The primary aims of the study are to (1) assess the feasibility of the intervention trial procedures, (2) the acceptability and feasibility of the intervention content and structure, and (3) explore the intervention’s preliminary effectiveness at increasing contraceptive use and affecting related outcomes among couples.DiscussionFilling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel, multi-level, community-based intervention to increase contraceptive use among couples with an unmet need for family planning in rural Uganda. We aim to use the findings of this pilot study to refine the trial procedures and intervention content for a future, larger cluster randomized controlled trial to establish the intervention’s efficacy.Trial registrationClinicalTrials.gov NCT04262882; registered on February 10, 2020.

Anticoagulant use to treat VTE (venous thromboembolism) in pregnancy: a review

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a medical condition that occurs when a blood clot forms in a deep vein that major cause of pregnancy-related maternal death. As pregnancy progresses, the risk of hypercoagulability increases, fibrinogen, factors VII, VIII, X and VWF (Von Willebrand Factor), plasminogen activator inhibitor-1, plasminogen activator inhibitor-2 are increases and 40-60% protein S decreases. Therefore, anticoagulant drugs are the mainstay of therapy for patients with VTE. The review aimed to select the best anticoagulant for pregnancy women with VTE. A scoping review was used. The type of articles reviewed were original articles obtained from four electronic journal databases published within 2012-2021. The main therapeutic agent recommended for use in the prevention and treatment of VTE in pregnancy is low molecular weight heparin (LMWH). LMWH has better bioavailability than other anticoagulants, has a lower risk of maternal bleeding, thromboembolic, thrombocytopenia and osteoporosis. The use of LMWH is actually better, more comfortable and safety for patients.

Abortion Surveillance - United States, 2020.

CDC conducts abortion surveillance to document the number and characteristics of women obtaining legal induced abortions and number of abortion-related deaths in the United States. 2020. Each year, CDC requests abortion data from the central health agencies for the 50 states, the District of Columbia, and New York City. For 2020, a total of 49 reporting areas voluntarily provided aggregate abortion data to CDC. Of these, 48 reporting areas provided data each year during 2011-2020. Census and natality data were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births), respectively. Abortion-related deaths from 2019 were assessed as part of CDC's Pregnancy Mortality Surveillance System (PMSS). A total of 620,327 abortions for 2020 were reported to CDC from 49 reporting areas. Among 48 reporting areas with data each year during 2011-2020, in 2020, a total of 615,911 abortions were reported, the abortion rate was 11.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 198 abortions per 1,000 live births. From 2019 to 2020, the total number of abortions decreased 2% (from 625,346 total abortions), the abortion rate decreased 2% (from 11.4 abortions per 1,000 women aged 15-44 years), and the abortion ratio increased 2% (from 195 abortions per 1,000 live births). From 2011 to 2020, the total number of reported abortions decreased 15% (from 727,554), the abortion rate decreased 18% (from 13.7 abortions per 1,000 women aged 15-44 years), and the abortion ratio decreased 9% (from 217 abortions per 1,000 live births).In 2020, women in their 20s accounted for more than half of abortions (57.2%). Women aged 20-24 and 25-29 years accounted for the highest percentages of abortions (27.9% and 29.3%, respectively) and had the highest abortion rates (19.2 and 19.0 abortions per 1,000 women aged 20-24 and 25-29 years, respectively). By contrast, adolescents aged <15 years and women aged ≥40 years accounted for the lowest percentages of abortions (0.2% and 3.7%, respectively) and had the lowest abortion rates (0.4 and 2.6 abortions per 1,000 women aged <15 and ≥40 years, respectively). However, abortion ratios were highest among adolescents (aged ≤19 years) and lowest among women aged 25-39 years.Abortion rates decreased from 2011 to 2020 among all age groups. The decrease in abortion rate was highest among adolescents compared with any other age group. From 2019 to 2020, abortion rates decreased or did not change for all age groups. Abortion ratios decreased from 2011 to 2020 for all age groups, except adolescents aged 15-19 years and women aged 25-29 years for whom abortion ratios increased. The decrease in abortion ratio was highest among women aged ≥40 years compared with any other age group. From 2019 to 2020, abortion ratios decreased for adolescents aged <15 years and women aged ≥35 and increased for women 15-34 years.In 2020, 80.9% of abortions were performed at ≤9 weeks' gestation, and nearly all (93.1%) were performed at ≤13 weeks' gestation. During 2011-2020, the percentage of abortions performed at >13 weeks' gestation remained consistently low (≤9.2%). In 2020, the highest percentage of abortions were performed by early medical abortion at ≤9 weeks' gestation (51.0%), followed by surgical abortion at ≤13 weeks' gestation (40.0%), surgical abortion at >13 weeks' gestation (6.7%), and medical abortion at >9 weeks' gestation (2.4%); all other methods were uncommon (<0.1%). Among those that were eligible (≤9 weeks' gestation), 63.9% of abortions were early medical abortions. In 2019, the most recent year for which PMSS data were reviewed for pregnancy-related deaths, four women died as a result of complications from legal induced abortion. Among the 48 areas that reported data continuously during 2011-2020, overall decreases were observed during 2011-2020 in the total number, rate, and ratio of reported abortions. From 2019 to 2020, decreases also were observed in the total number and rate of reported abortions; however, a 2% increase was observed in the total abortion ratio. Abortion surveillance can be used to help evaluate programs aimed at promoting equitable access to patient-centered quality contraceptive services in the United States to reduce unintended pregnancies.

Maternal deaths due to suicide and overdose in the state of Michigan from 2008 to 2018

Recent reports indicate that the contribution of deaths related to suicide and overdose are increasing, and may be the leading contributors to maternal mortality up to one year postpartum. This study aimed to provide a granular assessment of maternal deaths due to suicide or drug overdose in the state of Michigan from 2008 to 2018. This retrospective study involved a secondary review of deceased patients' records from 2008 to 2018 stored at the Michigan Department of Health and Human Services through the Michigan Maternal Mortality Surveillance Program. Pregnancy-related and pregnancy-associated deaths were reviewed. A descriptive analysis of maternal characteristics and identified trends was presented in deidentified aggregate form. There were 237 maternal deaths due to suicide or overdose from 2008 to 2018 included in the review. Overall, 70.9% had a documented psychiatric illness in their medical chart, with 48.1% having ≥2 psychiatric illnesses. However, only 34.5% (58/168) of these patients had documentation of taking psychotropic medication for their illness. Of those who died because of accidental or indeterminate substance overdose, 71.1% (138/194) had a known history of substance use disorder. Only 27.4% (43/157) of patients with a documented substance use disorder received medication-assisted treatment. Of those with substance overdose deaths, 42.9% had an opioid prescription, 44.3% had a benzodiazepine prescription, and 32.5% had a prescription for both. Prescription opioids were the most common substance found on postmortem toxicology report, and of these patients, 45.9% had a physician-prescribed opioid. Most pregnant individuals had documented significant risk factors for mental illness or substance use disorder; however, very few had documented pharmacologic therapy for their psychiatric or addiction illness. There is an urgent need to implement effective multidisciplinary health system mitigation strategies that address pregnancy and its intersection with behavioral health.

Cross-Sector Partnerships to Deliver Health Equity.

Cross-Sector Partnerships to Deliver Health Equity Wengora E. Thompson, DrPH, MPH (bio), Kelly Jean Thomas Craig, PhD (bio), Kyu B. Rhee, MD, MPP (bio), Sreekanth K. Chaguturu, Md (bio), and Joneigh S. Khaldun, Md, Mph, Facep (bio) The coronavirus disease 2019 (COVID-19) pandemic has been an awakening to the entire globe and has unveiled to the public long-standing and unaddressed social inequities in the United States (U.S.). Over one million people in the U.S. have lost their lives to this terrible disease,1 and the long-term health, economic, and psychological impacts—while still undefined in detail—are significant,2 and for many remain unaddressed. The impacts of the pandemic have been much greater among those who are historically marginalized;3 these groups include people of color, LGBTQIA+ populations, those living with a disability, immigrants, people living in rural areas, the elderly, and those with lower socioeconomic status (education, income, and occupation) including the uninsured/underinsured. In 2021, over 30 million people in the U.S. suffered from food insecurity,4 which can be a temporary or long-term condition; lack of consistent access to affordable nutritious food leaves many households hungry. Furthermore, in 2021 15% of all renters were behind on their rent payments resulting in housing insecurity and many evictions.5 These preventable conditions are inequitably distributed, falling more heavily on racial/ethnic minority groups and low socioeconomic status groups across many health conditions. For example, concerning U.S. rates of maternal morbidity and mortality, women of color face risks of pregnancy-related complications and death that are more than double those of White women.6 In other examples of health disparities, the burden of death and illness associated with chronic diseases (such as diabetes,7 hypertension,8 cardiovascular disease,8 cancer,9 sickle cell disease,10 and human immunodeficiency virus11) experienced by people of color is markedly heavier than that of White populations. Non-Hispanic Black people are twice as likely as non-Hispanic White people to die from diabetes.7 Furthermore, when compared with White people, Black people have hypertension that [End Page 1] is earlier-onset, harder to control, and associated with worse outcomes;12 the Black population has five times as many potentially preventable hospitalizations and more end-organ damage; half of the cardiovascular mortality disparity between Black and White populations is attributed to hypertension.8 These health disparities reflect harsh, longstanding inequities—often stemming from structural racism—in education, employment, housing, and health care that were exacerbated by the pandemic.2 The reasons for these inequities, and thus the solutions to address them, are complex and require input from and collaboration among multiple stakeholders, as well as genuine and sustained input and partnership with communities. Many organizations, both private (e.g., health care, technology, and private nonprofits) and public (government), are extending their reach by establishing cross-sector partnerships to initiate actions that promote health and wellness in communities, workplaces, schools, and other settings in addition to addressing social determinants of health (SDoH) for all community members. Recognizing the contributions of social and physical environment to health (i.e., SDoH) and cooperatively addressing needs—such as housing, food, safety, and transportation—have the potential to deliver a scaled and community-specific impact. Public-private partnerships can identify both the social and health needs of community members and offer the promise of improving health outcomes and reducing health care costs with tailored interventions, assistance programs, and other personalized resources. The focus of this supplemental issue is the potential of public-private partnerships to advance health equity and address unmet needs. CVS Health® has a longstanding history of identifying and addressing health disparities and inequities and using partnerships to integrate care and services based on comparable missions and complementary capacities. When Aetna®, acquired by CVS Health in 2018,13 became the first national health plan to collect race and ethnicity data in 2003,14 it was a progressive and unmatched step towards improving population health on behalf of payers. The acquisition of these standardized demographic data is key to identifying disparities in quality of care and targeting quality interventions to achieve equity. Further, the curation of an equity-centric...

Patient-Friendly Summary of the ACR Appropriateness Criteria: Suspected Pulmonary Embolism: 2022 Update.

Pulmonary embolism (PE) occurs because of a sudden blockage of a lung artery. PE is the third most common cardiovascular disease and a leading cause of pregnancy-related death. Not all cases of PE are fatal. PE usually occurs with deep vein thrombosis, which is a blood clot in a deep vein, such as in the leg. PE can be hard to identify, as symptoms of chest pain and shortness of breath are common among cardiovascular diseases. Various clinical criteria can be used to assess an individual’s risk for PE.

Black maternal health scholars on fire: Building a network for collaboration and activism.

Black maternal health scholars on fire: Building a network for collaboration and activism.

A descriptive study to assess the knowledge and expressed practices of primigravida mother’s regarding antenatal care and antenatal check-ups at selected government hospitals, Jodhpur, Rajasthan, India

Background: Pregnancy associated death remain high in developing countries. According to WHO, giving quality antenatal care will reduce pregnancy related diseases and deaths and thus protecting both antenatal mother and the baby. The world health organization reported that in 2015 around 830 women died every day from problems in pregnancy and childbirth. Only 5 lived in high-income countries. The rest lived in low-income countries. The WHO recommends that pregnant women should all receive four antenatal visits to spot and treat problems and give immunizations. Although antenatal care is important to improve the health of mother and baby, many women do not receive four visits.Methods: A quantitative approach, descriptive research design was used among 200 primigravida mothers coming to selected government hospitals, Jodhpur, Rajasthan, India by non-probability technique. Structured Questionnaire tools used to assess knowledge and expressed practices to assess antenatal care and antenatal check-ups. Data analysis was performed using Statistical Package for the Social Sciences version 20.Results: The study findings revealed that knowledge level of the primigravida mothers regarding antenatal care and antenatal check-ups out of 25 maximum score the mean knowledge score is 16.23. The expressed practices of the primigravida mothers regarding antenatal care and antenatal check-ups out of 17 maximum score the mean expressed practice score is 10.97. The study findings also revealed that significant association is present between sample characteristics and knowledge level. There is positive correlation (0.8121) found between knowledge and expressed practices.Conclusions: Knowledge and expressed practice regarding antenatal care and antenatal check-ups was average among primigravida mothers Umaid and MDM hospital, Jodhpur, Rajasthan.

Geographic disparities in peripartum cardiomyopathy outcomes

BACKGROUNDCardiomyopathy causes more than a third of late postpartum pregnancy–related deaths in the United States, and racial disparities in outcomes among pregnant individuals with cardiomyopathy exist. Underlying community factors may contribute to disparities in peripartum cardiomyopathy outcomes. OBJECTIVEThis study aimed to identify the geographic distribution of and disparities in peripartum cardiomyopathy outcomes, hypothesizing that patients living in communities with higher social vulnerability may have worse outcomes. STUDY DESIGNThis was a retrospective cohort study of patients with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 at a single center, excluding those with a post office box address as a post office box address may not reflect the census tract in which a patient resides. Severe peripartum cardiomyopathy (vs less severe peripartum cardiomyopathy) was defined as ejection fraction <30%, death, intensive care unit admission, left ventricular assist device or implantable cardioverter defibrillator placement, or transplant. The US census tract for the patient's address was linked to the Centers for Disease Control and Prevention Social Vulnerability Index, a 0 to 1 scale of a community's vulnerability to external stresses on health, with higher values indicating greater vulnerability. The Social Vulnerability Index includes social factors divided into socioeconomic, household composition, minority status, and housing type and transportation themes. The Social Vulnerability Index and Social Vulnerability Index components were compared among patients by peripartum cardiomyopathy severity. RESULTSOf 95 patients in the original cohort, 5 were excluded because of the use of a post office box address. Of the remaining 90 patients, 56 met severe peripartum cardiomyopathy criteria. At baseline, individuals with and without severe peripartum cardiomyopathy had similar ages, marital status, payor type, tobacco use, gestational age at delivery, and mode of delivery; however, individuals with severe peripartum cardiomyopathy were more likely to be Black (vs White) (59% vs 29%; P<.007) and less likely to recover ejection fraction (EF) to ≥55% by 12 months (36% vs 62%; P=.02) than individuals with less severe peripartum cardiomyopathy. Patients with severe peripartum cardiomyopathy were more likely to live in areas with a higher Social Vulnerability Index (0.51 vs 0.31; P=.002) and with more residents who were unemployed, impoverished, without a high school diploma, in single-parent households, of minority status, without a vehicle, and in institutionalized group quarters than patients with less severe peripartum cardiomyopathy. The median income was lower in communities of individuals with severe peripartum cardiomyopathy than in communities of individuals with less severe peripartum cardiomyopathy. CONCLUSIONPatients with severe peripartum cardiomyopathy outcomes were more likely to live in communities with greater social vulnerability than patients with less severe peripartum cardiomyopathy outcomes. To reduce disparities and maternal mortality rates, resources may need to be directed to socially vulnerable communities.

Enhanced Pregnancy-Related Death Data Elucidates Opportunities for Intervention

Enhanced Pregnancy-Related Death Data Elucidates Opportunities for Intervention

Women's risk of death beyond 42 days post partum: a pooled analysis of longitudinal Health and Demographic Surveillance System data in sub-Saharan Africa

WHO's standard definitions of pregnancy-related and maternal deaths only include deaths that occur within 42 days of delivery, termination, or abortion, with major implications for post-partum care and maternal mortality surveillance. We therefore estimated post-partum survival from childbirth up to 1 year post partum to evaluate the empirical justification for the 42-day post-partum threshold. We used prospective, longitudinal Health and Demographic Surveillance System (HDSS) data from 30 sites across 12 sub-Saharan African countries to estimate women's risk of death from childbirth until 1 year post partum from all causes. Observations were included if the childbirth occurred from 1991 onwards in the HDSS site and maternal age was 10-54 years. We calculated person-years as the time between childbirth and next birth, outmigration, death, or the end of the first year post partum, whichever occurred first. For six post-partum risk intervals (0-1 days, 2-6 days, 7-13 days, 14-41 days, 42-122 days, and 4-11 months), we calculated the adjusted rate ratios of death relative to a baseline risk of 12-17 months post partum. Between Jan 1, 1991, and Feb 24, 2020, 647 104 births occurred in the HDSS sites, contributing to 602 170 person-years of exposure time and 1967 deaths within 1 year of delivery. After adjustment for confounding, mortality was 38·82 (95% CI 33·21-45·29) times higher than baseline on days 0-1 after childbirth, 4·97 (3·94-6·21) times higher for days 2-6, 3·35 (2·64-4·20) times higher for days 7-13, and 2·06 (1·74-2·44) times higher for days 14-41. From 42 days to 4 months post partum, mortality was still 1·20 (1·03-1·39) times higher (ie, a 20% higher risk), but deaths in this interval would be excluded from measurement of pregnancy-related mortality. Extending the WHO 42-day post-partum threshold up to 4 months would increase the post-partum pregnancy-related mortality ratio by 40%. This multicountry study has implications for measurement and clinical practice. It makes the case for WHO to extend the 42-day post-partum threshold to capture the full duration of risk of pregnancy-related deaths. There is a need for a new indicator to track late pregnancy-related deaths that occur beyond 42 days, which are otherwise excluded from global maternal health surveillance efforts. Our results also emphasise the need for international agencies to disaggregate estimates by antepartum, intrapartum, postpartum, and extended post-partum periods. Additionally, the schedule and content of postnatal care packages should reflect the extended duration of post-partum risk. The UK Economic and Social Research Council.

Community-based referral transportation system for accessing emergency obstetric services in the Rohingya refugee camp during the COVID-19 pandemic in Bangladesh: facilitators and barriers through beneficiaries’ and providers’ lens using a mixed-method design

BackgroundDelays in seeking timely maternity care from health care professionals are crucial to address among the Rohingya population where many preventable pregnancy-related deaths occur within the camps when care is not sought. To address the challenges related to the referral of emergency and routine Sexual and Reproductive Health and Rights (SRHR) cases, United Nations Population Fund, through its partners, implemented a community-based referral transportation project called Referral hub. This paper presents the barriers and facilitators to the implementation of this referral transportation system from the perspectives of the beneficiaries and providers.MethodsThe research adopted a sequential explanatory mixed-method design. The quantitative phase consisted of a survey among 100 women while the qualitative phase comprised of in-depth interviews with a total of 12 mothers who used the services and key informant interviews with 21 providers.ResultsThe barriers identified for referral hub are discordant understanding of emergency, strict gender norms and practices, distrust in providers, poor roads and mobile phone networks. The facilitators are partnership with the community, within and other organizations.ConclusionThe study observed that the referral hub has a high potential to increase the utilization of SRHR services. Despite the barriers, the facilitating factors show a scope of improvement for these services.

Food taboos and associated factors among agro-pastoralist pregnant women: A community-based cross-sectional study in Eastern Ethiopia

In underdeveloped nations, cultural norms that are harmful to women's health, such as food taboos, are responsible for five to fifteen percent of pregnancy-related deaths. Food Taboo traditions prevent women from consuming particular foods, which reduces dietary diversity and food quality and may have detrimental nutritional effects. However, little is known about Ethiopia’s dietary taboos and related issues. So, the purpose of this study was to find out how common food taboos are among pregnant women in agro pastoralist settings, as well as the accompanying factors. 636 pregnant women were enrolled in a community-based cross-sectional study using a two-stage cluster sampling strategy, distributed over seven clusters. Data were exported from Epi Data version 3.01 to Statistical Package for Social Science version 20 after being entered. The prevalence of dietary taboos in this study was 67.4% (95% CI: 63.7%, 71.1%). Food taboos were independently and significantly predicted by lack of formal education [AOR = 1.97 (95% CI: 1.583, 4.496), low wealth index [AOR = 2.26 (95% CI: 1.173, 4.353)], absence of antenatal care visits [AOR = 6.16 (95% CI: 4.996, 10.128), lack of knowledge of maternal nutrition [AOR = 4.94 (95% CI: 3.799, 8.748)], and negative attitude toward maternal nutrition [ In the research area, dietary taboos were very common. Food taboos were independently predicted by low wealth index, lack of maternity care visits, lack of formal education, ignorance of maternal nutrition, and unfavorable attitudes. Therefore, it is highly advised that strong community-based maternal nutrition education and counseling, raising women's income, and preparing young women for study in order to improve their educational standing be implemented.

Evaluation of Demographic, Clinical and Autopsy Data of Autopsied Maternal Deaths in Turkey

Aim: Maternal mortality is an important public health issue. In this study, it is aimed to evaluate pregnancy related maternal deaths in a multi-dimensional manner, focusing on not only demographic and clinical characteristics but also autopsy results by including the maternal death cases having autopsy reports.&#x0D; Material and Method: There were 1037 pregnancy related deaths in Turkey, between 2010 and 2014, and 17.3 % (n=180) of them had an autopsy report. Autopsied maternal deaths were evaluated in this sutdy. Data of autopsied pregnancy related deaths were obtained from the nationwide registration system of Woman and Reproductive Health Department of Turkish Ministry of Health and Turkish Ministry of Justice-Council of Forensic Medicine and evaluated retrospectively. Characteristics and cause of maternal deaths autopsied between 2010 and 2014 were evaluated. Age, cause of death, pregnancy state at the time of death, place of birth, mode of delivery, time of death, pregnancy outcomes, place of death, and delay-model were evaluated.&#x0D; Results: In this study, 61.1% (n=110) of all pregnancy related deaths were ≥30 years of age. Direct maternal deaths were 35% (n=63) of the cases, such as hemorrhage 14.5% (n=26), embolus 6.7% (n=12), uterine rupture 5% (n=9), preeclampsia/eclampsia 4.4% (n=8) and others 4.4% (n=8). Indirect maternal deaths were 56.1% (n=101) of the cases, such as cardiovascular disease 37.2% (n=67), infection 7.8% (n=14), cerebrovascular disease 6.7% (n=12), and others 4.4% (n=8). In 8.9% (n=16) of the cases, the cause of death was not determined. Deaths occurred in the postpartum period in 61.1% (n=110) of the cases. Deaths occurred in a healthcare facility in 71.1% (n=128) of the cases. One or more delays were determined in 33.9% (n=61) of the cases. &#x0D; Conclusion: According to the results of the present study, cardiovascular disease related to maternal mortality has been found to be an increasing, important public health concern to consider for maternal health routines. In addition, as a second outcome of this study, we can emphasize that, although, the exact cause of death could not be determined even after autopsy in 16 cases (8.9%), autopsy is still one of the most valuable assessment tools to highlight important possible clinical and administrative improvements to reduce maternal mortality.

Addressing Racial Disparities in Pregnancy-Related Deaths: An Analysis of Maternal Mortality-Related Federal Legislation, 2017-2021.

There has been increasing national attention to the issue of racial disparities in pregnancy-related deaths. Federal legislation can support approaches at multiple levels of intervention to improve maternal health. As part of the CDC Policy Academy, a team of CDC staff completed a policy analysis to determine the approaches addressed in federal legislation to reduce racial disparities in pregnancy-related deaths. We analyzed federal maternal mortality legislation introduced January 2017 through December 2021. Common approaches addressed by the legislation were categorized into themes and reviewed for their alignment with approaches identified in clinical and public health literature to reduce pregnancy-related deaths, with an emphasis on social determinants of health (SDOH) approaches and reducing racial disparities. Thirty-seven unduplicated bills addressed pregnancy-related deaths, including 27 House or Senate bills that were introduced but not passed, 6 resolutions highlighting the maternal health crisis, 2 bills that passed the House only, and 2 bills enacted into law (Preventing Maternal Deaths Act of 2018 and Protecting Moms Who Served Act). The most common themes mentioned in federal legislation were improving maternal health care, addressing health inequities and SDOH, enhancing data, and promoting women's health. Legislation focused on health inequities and SDOH emphasized implicit bias training and improving SDOH, including racism and other social factors. The reviewed federal legislation reflected common clinical and public health approaches to prevent pregnancy-related deaths, including a significant focus on reducing bias and improving SDOH to address racial disparities.

Adverse Events in Maternal Care: Investigating Racial/Ethnic Disparities at the System Level

Pregnancy related deaths are elevated among women of color, and Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women. Women of color also experience higher rates of severe maternal morbidity (SMM). Half of all maternal deaths and SMM cases are considered preventable with timely and appropriate care. Poor maternal health outcomes and racial/ethnic disparities are the result of multilevel variables including poor quality of care. Few studies have investigated the underlying mechanisms within clinical systems that undermine safety for women of color. This research investigates systems issues contributing to adverse outcomes in maternal care and disparities based on the examination of patient safety incidents (PSIs) reported in the obstetric care units in a large, academic health system in 2019 and 2020. Trends in event type and harm score were examined and the data was disaggregated by race/ethnicity and cross tabulated with unit, event type, and harm score to examine disparities in adverse events. Of the 693 reported incidents, non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients accounted for 43.8% each. Hispanic patients accounted for 7.9% of reported incidents and patients categorized as “Other” accounted for 4.3% of the reported incidents. In both 2019 and 2020, the odds ratio demonstrated a higher likelihood of a reported event for non-Hispanic Black patients (1.99, 95%CI, 1.56 -2.52 and 1.70, 95% CI 1.28-2.25, respectively) and patients categorized as “Other” (15.34, 95% CI 7.25-32.44 and 4.43, 95%CI 1.85-10.58). These findings can facilitate the identification of mechanisms within the clinical system contributing to variation in adverse outcomes for women of color and support the design of more precise interventions and sustained, effective delivery.