Proportion Of Maternal Deaths Research Articles

THE RELATIONSHIP OF CUSTOMS, KNOWLEDGE AND AFFORDABILITY OF FACILITIES AND INFRASTRUCTURE TO AID SELECTIONS LABOR

Introduction: Indonesia is aggressively targeting reducing the maternal mortality rate to 70 deaths per 100 thousand live births by 2030. Currently, the proportion of maternal deaths is approximately 305 deaths per 100 thousand live births. Where the biggest deaths occur in hospitals around 77%. The mother could not be saved, for one thing, because the mother who was referred to the hospital was already in a state of severe complications. This happens because identification and examination during pregnancy are not optimal and must be strengthened (RI Ministry of Health, 2021). Purpose of Writing: The purpose of this writing is to find out cultural relations, affordability of facilities and infrastructure and mothers' perceptions of the behavior of choosing delivery assistance in the working area of the Cisimeut Health Center in 2022. The sample in the study was 42 mothers who had given birth in January-December 2022. Research Method : This research method is descriptive analytic, namely research that tries to explore how and why the phenomenon occurs, then analyzes the dynamics of the correlation between these phenomena. Research Results: there is no significant relationship between Culture or Customs and Choice of Birth Assistance Behavior in the Work Area of the Cisimeut Health Center in 2022 Continuity Correction value p = 0.478 means that p value ≥ 0.05, there is a relationship between affordability of facilities (Continuity Correction value p = 0.023) , knowledge (Continuity Correction value p = 0.001) on the behavior of choosing delivery assistance in the Work Area of the Cisimeut Health Center in 2022 Conclusions and Suggestions: There is no significant relationship between culture and behavior in choosing delivery assistance in the working area of the Cisimeut Health Center in 2022.

Levels, Trends, and Causes of Adolescent and Young Adult Maternal Mortality in Nigeria During 1990–2017: Analysis of the 2017 Global Burden of Disease Study Database

Background: Despite the global progress made in reducing maternal mortality in the past two decades, the health of adolescents and young adult women (10-24 years) has been neglected based on the wrong assumption that they are healthy, especially in a developing country like Nigeria; this is despite the fact that adolescents and young adults (AYA) constitute over 16% of Nigeria’s population. Thus, this study aimed to determine the levels, trends, and causes of maternal mortality among AYA women aged 10-24 years in Nigeria. Methods: This was a cross-sectional study that utilized secondary data sets running from 1990 to 2017 from the Global Burden of Disease Study’s (GBD) online interactive tool downloaded from the Global Health Data Exchange (GHDx) platform. From the database, we extracted the numbers of maternal deaths (10-49 years), adolescent and young adults’ maternal deaths (10-24 years), the proportion of maternal deaths (10-24 years), and both maternal mortality ratio and rate for 15-49 years old and 10-24 years old in the form of Comma separated values (CSV) and converted into XLS file in Microsoft (MS) Excel format for the analysis. Frequencies, proportions, and charts were generated using MS Excel. Result: A total of 122,107 maternal deaths occurred among adolescents and young adults (AYA), which is 26% of all deaths occurring among 10-49 years old. Year-to-year changes in the absolute numbers of maternal deaths among AYA showed that it ranged from 3,866 (1990) to 4,451 (2017), showing a slight upward increase over the period; however, both AYA maternal mortality ratio and rate show consistent declines over the period. AYA maternal mortality ratio (MMR) for adolescents aged 15-19 years was 17% higher than for young adults aged 20-24 years. Sepsis was the leading cause of adolescent maternal death (MMR of 168), followed by maternal hypertensive disorder, obstructed labor, maternal hemorrhage, ectopic pregnancy, and abortion. A total of 460,155 maternal deaths occurred in women aged 10-49 years during the study period. Maternal deaths in the age group 10-24 years ranged from 3,866 (29.8%) in 1990 to 4,451 (25.1%) in 2017. The maternal mortality ratio in women aged 10-49 years declined by about 30% for the 1990 – 2017 period. Conclusion and Implications for Translation: The study showed that adolescents and young adults are at increased risk of maternal deaths in Nigeria. Therefore, multi-faceted maternal health programs in the country need to target this age group to prevent maternal deaths. Copyright © 2022 Dahiru et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Maternal near miss and mortality attributable to hypertensive disorders in a tertiary hospital, Tanzania; a cross-sectional study

BackgroundHypertensive disorders in pregnancy is the second most common direct cause of maternal deaths accounting for 14% of maternal deaths worldwide. Severe pre-eclampsia and eclampsia are among the hypertensive disorders in pregnancy causing significant morbidity and mortality, hence categorized as Maternal Near Miss. At Muhimbili National Hospital these are the leading causes of maternal deaths accounting for 19.9% of maternal death. This study aimed to determine the proportion of severe maternal outcomes and maternal near-miss indices among patients with severe pre-eclampsia and eclampsia at Muhimbili National Hospital in Tanzania.MethodsA descriptive cross-sectional study was conducted between September 2017 to January 2018 at Muhimbili National Hospital. Women with severe pre-eclampsia and eclampsia were recruited. Data were extracted from patient files after admission, and followed up until discharge or death; after discharge was categorized as maternal near miss or death as maternal death. The outcome indicators were calculated using the total number of live births during the study period, the number of maternal deaths and maternal near-miss due to severe pre-eclampsia/ eclampsia in the same period.ResultsNearly two-thirds of women recruited, 199 (62.2%) had severe preeclampsia while 121 (37.8%) had eclampsia, 71 (22.1%) had severe maternal outcome whereby 63 had maternal near-miss with organ dysfunction and 8 maternal deaths. The overall maternal near-miss ratio was 87.4 while that for severe pre-eclampsia was 54, and 33 per 1000 live births for eclampsia. Overall severe maternal outcome ratio was 19.4 while that for severe pre-eclampsia was 12 and that for eclampsia was 9.5 per 1000 live births. Mortality index was 11% and the Case fatality rate was 2.5%.ConclusionThere is a high proportion of women with severe maternal outcome attributable to severe pre-eclampsia and eclampsia, with a reduced proportion of maternal deaths. This signifies improvement of performance in our facility in dealing with patients with severe morbidities due to severe pre-eclampsia and eclampsia, however, more effort should be put to further reduce maternal mortality.

Evaluation factors affecting the maternal mortality among pregnant women during 2001–2011 in Ardabil Province, Iran

Background: considering health indicators, analyzing pregnant women population is an important subject and mortality degree among this population is disastrous. According to the World Health Organization, annually 600,000 women die due to side-effects of pregnancy and delivery; it means that 1600 women die daily and one woman dies in each minute because of progeny side-effects. The average of MMR is 200 in developing countries and it is 20 out of 1000 in developed countries. This study was done aimed to determine the rate of maternal mortality among pregnant women and the factors affecting it in the Ardabil province so that identified dominant effective factors and presented Executive Solutions for reducing maternal mortality. Methods: This study was conducted as a cross-sectional and descriptive-analysis study by using existing data in the health centre network system of Ardabil province during 2001–2011. According to the information of all maternal deaths (50 cases) in the health care system, the causes of death were extracted by study and evaluation of the documents and questionnaires about and the control group information have been collected randomly in the ratio of 1 to 4 (N = 200). Data was analyzed by using the Statistical tests as Chi-square, t2test and regression with the SPSS.20 software. Results: findings showed that the proportion of maternal deaths is 20 per 100,000 live births in Ardabil province. 70% of maternal death was direct because of pregnancy’s side-effects.68% of deaths occurred in the postpartum period. The common causes of death were respectively, the bleeding (28%), preeclampsia, eclampsia and its side-effects (16%) were thromboembolic disorders (16%) and infection (8%). The maximum number of deaths were in the years 2003 and 2011 (18%) and the minimum number of these were 2008 (zero). 72% of maternal deaths were in the age range of 18 to 35 years. 33% of mothers were illiterate and less educated (the primary school). 62% of died mothers, lived urban residents. In this study, the relationship between cares before pregnancy, suffering from different diseases during pregnancy and distance between two pregnancy times were evaluated by Logistic regression test which was significant. Conclusions: The most effective factors to reduce the maternal deaths in the province were increased coverage of pre-pregnancy, pregnancy and postpartum cares and improving its quality.

How can ways of working with others be developed to improve perinatal mental health care?

There is a national drive to improve perinatal mental healthcare, as a significant proportion of maternal deaths are attributed to mental health problems. This report will evaluate how ways of working with others could be developed to improve perinatal mental healthcare, by linking theoretical frameworks and models to practice. There are many ways in which working together can improve perinatal mental healthcare, including partnering with other organisations such as charities to use available resources; developing interprofessional training sessions and communities of practice to enhance learning; encouraging collective leadership to support and motivate staff to advance healthcare practice; and encouraging effective teamwork to reiterate goals and build strong relationships. Systemic changes must be made to improve perinatal mental health care to address people's physical, social and psychological needs.

English

Nigeria accounts for a considerable proportion of maternal deaths that occur annually worldwide. The study investigated the incidence of pre-pregnancy and pregnancy-related illnesses in women accessing antenatal care services at health facilities in Awka South Local Government Area, Anambra State. The study adopted cross-sectional research design. The population comprised 3,207 registered pregnant women from January to September 2012. The sample for the study consisted of 650 pregnant women. A pre-tested questionnaire was administered by the interviewers to women who had attended antenatal care services within six months prior to the date of data collection. Malaria (66.6%), morning sickness (58.0%), hyperemesis gravidarum (39.7%), sexually transmitted infections (28.6%), gestational diabetes (23.8%), pre-eclampsia and eclampsia (23.0%) and anaemia (15.8%) were the common illnesses in women. There were statistically significant differences in the women’s pre-pregnancy illnesses according to the level of education (p = 0.032) and pregnancy-related illnesses according to age (p = 0.023) and level of education (p = 0.045). It was concluded that the interplay of several factors is responsible for the incidence of pre-pregnancy and pregnancy-related illnesses in women. Identification of these factors is expedient while scaling up of maternal health interventions; improved access and uptake of facility-based care hopefully, will drastically reduce morbid conditions in women and improve maternal and newborn outcomes. Key words: Prevalence, Pregnancy-related illnesses, antenatal care, maternal health.

Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana

BackgroundDespite the introduction of the Millennium Development Goal to reduce maternal deaths from 400 to 100 per 100,000 live births, the proportion of maternal deaths is still much higher in most developing countries like Ghana. Various interventions have been implemented in Ghana that focus on increasing skilled maternal care. These are especially needed in rural areas. EHealth has the potential to contribute to reducing the challenges in maternal healthcare (MHC) that poor areas suffer. This paper analyzes the potential of eHealth solutions to improve maternal health in rural Ghana as well as the challenges to their implementation. The work was carried out in cooperation with the local health directorate of Kpando Municipality, one of the administrative areas in the Volta Region.MethodsThe study is focused on remote peninsulas and islands in Kpando Municipality. Data was gathered through triangulated research methods. Maternal health challenges were identified using the Three Delays Model for MHC. The three delays are delay in seeking care, delay accessing health facilities, and delay receiving adequate care. Challenges to the implementation of eHealth solutions in remote communities were analyzed using the Drury’s 5C eHealth model for developing countries. The 5Cs correspond to context, community, capacity, connectivity, and content.ResultsThe results show that financial dependence of women, a decision-making process based on previous experiences and traditional beliefs, competitiveness between facilities, organizational loopholes, lack of equipment, and geographical situations directly influence MHC outcomes. EHealth solutions, thanks to the high number of health workers with basic IT skills, have high potential to reduce MHC delays. However, poverty, cultural beliefs, organizational issues, connectivity, and lack of human resources were identified as main challenges to the implementation of eHealth solutions.ConclusionIn Ghana’s rural areas the three delays proposed in the model affect the outcomes of MHC. These delays are influenced by socio-economic status, access to facilities, and quality of care. EHealth solutions show great potential to reduce the delays. Based on the 5C model, a mHealth solution aiming to improve guidance during pregnancy was outlined.

The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature.

BackgroundWhile the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for causes of maternal deaths among adolescents are the same as for older women. This study systematically reviews the literature on cause of maternal death in adolescence. Where possible we compare the main causes for adolescents with those for older women to ascertain differences and similarity in mortality patterns.MethodsAn initial search for papers and grey literature in English, Spanish and Portuguese was carried out using a number of electronic databases based on a pre-determined search strategy. The outcome of interest was the proportion of maternal deaths amongst adolescents by cause of death. A total of 15 papers met the inclusion criteria established in the study protocol.ResultsThe main causes of maternal mortality in adolescents are similar to those of older women: hypertensive disorders, haemorrhage, abortion and sepsis. However some studies indicated country or regional differences in the relative magnitudes of specific causes of adolescent maternal mortality. When compared with causes of death for older women, hypertensive disorders were found to be a more important cause of mortality for adolescents in a number of studies in a range of settings. In terms of indirect causes of death, there are indications that malaria is a particularly important cause of adolescent maternal mortality in some countries.ConclusionThe main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further.

Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis.

The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries. In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries. Studies were included if they assessed maternal and perinatal outcomes in pregnant women exposed to anaesthesia for an obstetric procedure in countries categorised as low-income or middle-income by the World Bank. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990 to ensure that the estimates reflect the current burden of the condition. Two independent reviewers undertook quality assessment and data extraction. We computed odds ratios for risk factors and anaesthesia-related complications, and pooled them using a random effects model. This study is registered with PROSPERO, number CRD42015015805. 44 studies (632,556 pregnancies) reported risks of death from anaesthesia in women who had an obstetric surgical procedure; 95 (32,149,636 pregnancies and 36,144 deaths) provided rates of anaesthesia-attributed deaths as a proportion of maternal deaths. The risk of death from anaesthesia in women undergoing obstetric procedures was 1·2 per 1000 women undergoing obstetric procedures (95% CI 0·8-1·7, I(2)=83%). Anaesthesia accounted for 2·8% (2·4-3·4, I(2)=75%) of all maternal deaths, 3·5% (2·9-4·3, I(2)=79%) of direct maternal deaths (ie, those that resulted from obstetric complications), and 13·8% (9·0-20·7, I(2)=84%) of deaths after caesarean section. Exposure to general anaesthesia increased the odds of maternal (odds ratio [OR] 3·3, 95% CI 1·2-9·0, I(2)=58%), and perinatal deaths (2·3, 1·2-4·1, I(2)=73%) compared with neuraxial anaesthesia. The rate of any maternal death was 9·8 per 1000 anaesthetics (5·2-15·7, I(2)=92%) when managed by non-physician anaesthetists compared with 5·2 per 1000 (0·9-12·6, I(2)=95%) when managed by physician anaesthetists. The current international priority on strengthening health systems should address the risk factors such as general anaesthesia and rural setting for improving anaesthetic care in pregnant women. Ammalife Charity and ELLY Appeal, Bart's Charity.

Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India.

To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care.

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Objectives Assessment of all maternal deaths and the proportion of maternal deaths related to International Disease Code (CID-10) O.10–O.16) reported by DATASUS (Brazilian Health Ministry) from 2003 to 2012. Methods Data were from http://www2.datasus.gov.br . (Accessed June 14, 2014): total live births, total MM, total MM due to hypertensive disorders. The MMR was calculated n[o] MM/n[o] live births per 100.000 and percentage of hypertensive disorders over total MM. Results Graphic 1 shows the MM rates and the proportion of hypertension in pregnancy (HP) in the total deaths. Disparities are detected among regions: North and Norwest have higher MMR (×25.0) and South the better MMR among all (×16,1). Conclusions MM in Brazil remains at worrying levels and with a trend of stagnation. The same can be supposed for the proportion of deaths related to hypertensive disorders. These problems are directly related to the quality of prenatal care and all health system. These indicators should guide public politics and expose the urgent needs for a task force to improve not only the quality of maternal care but also start a permanent auditing committee in order to provide an effective agenda until effective decline of these numbers. Support: FAPESP Process 2014/00213-7. Disclosures N. Sass: None. M.R. Silveira: None. L.G. Oliveira: None. T.A. Facca: None. J.L. Sato: None. H.A. Korkes: None. M.R. Mesquita: None.

Regional and district level estimates of maternal mortality for Nepal: Are they different from the national estimates in 2011?

Introduction: Nepal won Millennium Development Goal Award on Maternal Health as the Maternal Mortality declined by 50% between 1996 and 2006 and by 80% between 1990 and 2010. However, maternal mortality in Nepal are estimated from Surveys using direct and indirect techniques amid the absence of robust vital registration system. Thus, maternal mortality estimates are not available at regional and district levels.
 Methods: This paper estimated the regional and district level maternal mortality ratio for 2011 using multilevel regression model coefficients proposed by UN and World Bank for the first time in Nepal. Proportion of Maternal Deaths were estimated using Gross Domestic Product, General Fertility Rate and delivery by Skilled Birth Attendants. The maternal mortality ratio for five development regions and 75 districts were then estimated using the 2011 Census Reports.
 Results: The maternal mortality ratio at 2011 was estimated as 155 deaths per 100,000 live births and was consistent with the previous values estimated between 1990 and 2010. Maternal mortality at Western and Central development regions were below while Eastern, Mid-Western and Far-Western Regions were above the national estimate. Twenty-two districts had it below while 53 had it above the national estimate. Kalikot and Kaski districts had highest and lowest maternal mortality ratio in 2011.
 Conclusion: Maternal mortality declined in the country because of rapid fertility decline and increased contraceptive use and decreased anemia among pregnant women and obstetrics/abortion facilities in all districts of the country after legalization of abortion. Improvement in women’s education, empowerment, wealth and living standard were also responsible for declining maternal mortality. Nepal now needs a robust vital registration system to “explain” the reasons of this decline and further devise and implement new plans, policies and programs to reduce it further at sub-national and local levels.

Amniotic Fluid Embolism (AFE) in China: Are maternal mortality and morbidity preventable?

A case of hospital-patient conflict has occurred in China that has lifted billows in the public and highlighted the lethality of amniotic fluid embolism (AFE). AFE is a rare but severe obstetric complication with high maternal mortality and morbidity. Globally, the incidence of AFE is estimated to be approximately 2 to 6 per 100,000 deliveries. The maternal mortality rate (MMR) attributable to AFE ranges between 0.5 to 1.7 deaths per 100,000 deliveries in the developed world and 1.9 to 5.9 deaths per 100,000 deliveries in the developing world. In developed countries, AFE often accounts for a leading cause of maternal mortality; whereas the proportion of maternal death caused by AFE tends to be not as dominant compared to common perinatal complications in developing countries. With the mechanism remaining to be elucidated, AFE can neither be predicted nor prevented even in developed countries. Treatment requires a set of highly intensive advanced emergency obstetric care, challenging obstetric care in developing countries. Although this complication is currently far from preventable, China has potential to improve the prognosis of AFE by strengthening the emergency obstetric care system.

An Evaluation of the Safe Motherhood Hospital Program

The Safe Motherhood Hospital program aims to improve maternal and child health and reduce mortality among mother and child. The program has been in place for 10 years, but there has been no impact evaluation of the program. In this research, we evaluate whether the program has an impact on maternal mortality and the cost of child delivery. The research uses Propensity Score Matching (PSM) technique that widely used for non-experimental studies. PSM has been a popular approach to estimate causal treatment effects, particularly when evaluating labour market policies and social programs. The technique is considered inexpensive and very useful for evaluating public projects in Thailand where projects have been implemented without a prior design for impact evaluation. From out analysis, we find that number of changes of director of the hospital, geographic factors, size of catchment area, socio-demographic structure of the district and hospital resources are statistically significant determinants of SMH program participation both before 2004 and 2005. Using various weighting and matching methods, we find that the SMH program has no impact on the proportion of maternal death to child delivery. The program, however, can reduce cost (i.e. length of stay for birth giving and labour cost) of participating hospitals. Given that the program does not allocate more resources to the participating hospitals, its guidelines can reduce the cost of child delivery without increasing the death rate. This could be considered as a success of the program. The findings also show that the program encourages referral. However, referral among community hospitals may be contaminated by the way the NHSO financed referral cases.

Grim Face of Maternal Mortality at Tertiary Care Hospital of Rural India: A 16 Years Study

Background: World health assembly set the millennium development goals (MDG) -5, with the aim of reduction in maternal mortality below 100 per 100,000 live births by year 2015. A maternal death is a very sensitive index that reflects the quality of reproductive care provided to the women of the reproductive age. It has serious implications to the family, the society and the nation. The burden of maternal mortality is quite high in India at 254 deaths per 100,000 live births as per the data of Sample Registration System (SRS) for the period 2004-06. However, India is committed to meet the MDG-5 target of less than 100 deaths per 100,000 live births by the year 2015. Objectives: To assess the proportion, causes and time trends of maternal deaths in a tertiary care hospital of rural India. Method: A retrospective hospital based study of 119 maternal deaths over a period of 16 years from January 1994 to December 2009. Results: Over the study period, there were 20,801 deliveries, giving a proportion of maternal deaths of 572/1,00,000 live births. Postpartum hemorrhage was the leading direct cause while infective hepatitis was indirect cause of maternal mortality. Most women died within 24 hours of admission to hospital. There was significant reduction in total number of deaths due to eclampsia and sepsis in last ten years. Conclusions: The proportion of maternal deaths in rural area is much higher than the national figure of 254 maternal deaths per 100,000 live births, yet most deaths in study area could have been avoided by minimizing the three delays i.e. delay in decision to seek care; delay in reaching care and delay in receiving care and by promoting overall safe motherhood.

Comment réduire la mortalité maternelle?

Maternal mortality is still very high in developing countries. A large proportion of maternal deaths are due to delayed or substandard emergency obstetric care. There is an urgent need to develop and validate interventions designed to improve the management of obstetric complications. There is some experimental or quasi-experimental evidence supporting interventions that reduce delays in the treatment of obstetric emergencies in resource-poor settings. Most are community-based interventions that provide funds for transport and public education, or that improve the referral system and medical practices at the different levels of care. The most effective measures are facility-based review's of maternal deaths and near-misses, and referral interventions. More research is needed to understand precisely how these interventions improve maternal and neonatal outcomes.

Liability Associated With Obstetric Anesthesia: A Closed Claims Analysis

Obstetric Anesthesia Digest: December 2009 - Volume 29 - Issue 4 - p 183 doi: 10.1097/01.aoa.0000362061.27989.1e

Liability Associated with Obstetric Anesthesia

Obstetrics carries high medical liability risk. Maternal death and newborn death/brain damage were the most common complications in obstetric anesthesia malpractice claims before 1990. As the liability profile may have changed over the past two decades, the authors reviewed recent obstetric claims in the American Society of Anesthesiologists Closed Claims database. Obstetric anesthesia claims for injuries from 1990 to 2003 (1990 or later claims; n = 426) were compared to obstetric claims for injuries before 1990 (n = 190). Chi-square and z tests compared categorical variables; payment amounts were compared using the Kolmogorov-Smirnov test. Compared to pre-1990 obstetric claims, the proportion of maternal death (P = 0.002) and newborn death/brain damage (P = 0.048) decreased, whereas maternal nerve injury (P < 0.001) and maternal back pain (P = 0.012) increased in 1990 or later claims. In 1990 or later claims, payment was made on behalf of the anesthesiologist in only 21% of newborn death/brain damage claims compared to 60% of maternal death/brain damage claims (P < 0.001). These payments in both groups were associated with an anesthesia contribution to the injury (P < 0.001) and substandard anesthesia care (P < 0.001). Anesthesia-related newborn death/brain damage claims had an increased proportion of delays in anesthetic care (P = 0.001) and poor communication (P = 0.007) compared to claims unrelated to anesthesia. Newborn death/brain damage has decreased, yet it remains a leading cause of obstetric anesthesia malpractice claims over time. Potentially preventable anesthetic causes of newborn injury included delays in anesthesia care and poor communication between the obstetrician and anesthesiologist.

This Month in Anesthesiology

The authors reviewed recent obstetric claims in the American Society of Anesthesiologists Closed Claims database. Claims for injuries from 1990 to 2003 were compared with obstetric claims for injuries prior to 1990. Compared with pre-1990 obstetric claims, the proportion of maternal death and newborn death/brain damage decreased, whereas maternal nerve injury and maternal back pain increased in claims from 1990 or later. In claims from 1990 or later, payment was made on behalf of the anesthesiologist in only 21% of newborn death/brain damage claims compared with 60% of maternal death/brain damage claims. These payments in both groups were associated with an anesthesia contribution to the injury and substandard anesthesia care. Potentially preventable anesthetic causes of newborn injury included delays in anesthesia care and poor communication between the obstetrician and anesthesiologist. See the accompanying Editorial View on page 8 Manual in-line stabilization (MILS) is recommended during direct laryngoscopy and intubation in patients with known or suspected cervical spine instability. The authors hypothesized that anesthesiologists would apply greater pressure during intubations with MILS than without. Nine patients underwent two sequential laryngoscopies and endotracheal intubations, one with MILS and one without. Pressures applied to airway tissues during laryngoscopy were measured and glottic view was characterized. With MILS, glottic visualization was worse in six patients. Maximum laryngoscope pressure was greater with MILS than without. In the presence of cervical instability, impaired glottic visualization and secondary increased pressure application with MILS have the potential to increase pathologic cranio-cervical motion. See the accompanying Editorial View on page 6 Hemoglobin-based oxygen-carrying solutions (HBOC) provide emergency alternatives to blood transfusion. Two primary concerns limiting the clinical acceptance of acellular HBOC are the occurrence of systemic and pulmonary vasoconstriction. The authors examined the impact of HBOC-201 infusion with or without inhaled nitric oxide on pulmonary vascular tone in healthy, awake lambs. Pretreatment with inhaled nitric oxide (80 ppm) for 1 h followed by breathing a lower concentration of nitric oxide (5 ppm) during and after HBOC-201 infusion prevented systemic and pulmonary vasoconstriction. These findings demonstrate that pretreatment with inhaled nitric oxide followed by breathing a lower concentration of nitric oxide allowed administration of an acellular hemoglobin substitute without vasoconstriction.Statin drugs have been shown to reduce adverse perioperative events. The objective of this study was to determine if there was an association between preoperative administration of statins and postoperative delirium in a prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit. Multivariable logistic regression analysis was used to identify independent perioperative predictors of delirium. Of the 1,059 patients analyzed, 122 patients had delirium. Administration of statins reduced the odds of delirium after cardiac surgery with cardiopulmonary bypass by 46%. A prospective placebo-controlled clinical trial will be required to validate these findings.There was a higher success rate with the GlideScope technique in untrained personnel as compared with direct laryngoscopy.Remifentanil markedly increased central apneas in a subset of subjects.The inclusion of intraoperative elements improves the ability to predict cardiac adverse events after noncardiac surgery.The incidence and mortality of malignant hyperthermia in the United States are higher than previously reported.