Risk Of Maternal Mortality Research Articles

Predicting maternal risk level using machine learning models

BackgroundMaternal morbidity and mortality remain critical health concerns globally. As a result, reducing the maternal mortality ratio (MMR) is part of goal 3 in the global sustainable development goals (SDGs), and previously, it was an important indicator in the Millennium Development Goals (MDGs). Therefore, identifying high-risk groups during pregnancy is crucial for decision-makers and medical practitioners to mitigate mortality and morbidity. However, the availability of accurate predictive models for maternal mortality and maternal health risks is challenging. Compared with traditional predictive models, machine learning algorithms have emerged as promising predictive modelling methods providing accurate predictive models.MethodsThis work aims to explore the potential of machine learning (ML) algorithms in maternal risk level prediction using a nationwide maternal mortality dataset from Oman for the first time. A total of 402 maternal deaths from 1991 to 2023 in Oman were included in this study. We utilised principal component analysis (PCA) in the ML algorithms and compared them to the results of model performance without PCA. We employed and compared ten ML algorithms, including decision tree (DT), random forest (RF), K—Nearest Neighbors (KNN), Naïve Bayes (NB), Extreme Gradient Boosting (xgboost), Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis (QDA), Logistic Regression (LR), Support Vector Machine (SVM) and Artificial Neural Network (ANN). Different metrics, including, accuracy, sensitivity, precision, and the F1- score, were utilised to assess Model performance.ResultsThe results indicated that the RF model outperformed the other methods in predicting the risk level (low or high) with an accuracy of 75.2%, precision of 85.7% and F1- score of 73% after PCA was applied.ConclusionsWe applied several machine learning models to predict maternal risk levels for the first time using real data from Oman. RF outperformed the other algorithms in this classification problem. A reliable estimate of maternal risk level would facilitate intervention plans for medical practitioners to reduce maternal death.

Predictors of successful vaginal birth after one caesarean section at selected hospitals in Lusaka, Zambia

Background. Repeat caesarean section (CS) carries an increased risk of both maternal and neonatal morbidity and mortality. Planned vaginal birth after CS (VBAC), with an estimated success rate of 60 - 80%, is clinically safer than elective repeat CS, and also limits the rise in CSs. There is no single generalised validated tool to predict success of VBAC. Objectives. To determine predictors of successful VBAC among mothers with one previous CS at selected hospitals in Lusaka, Zambia. Method. Determination of independent predictors with significant high odds of a successful VBAC among mothers offered a trial of labour (TOL) was conducted in a cross-sectional study. Women with a history of one previous lower-segment CS, who were carrying a singleton fetus and were in established labour or draining amniotic fluid and scheduled for TOL after CS, were included in the study. Convenience sampling was used to enrol 290 participants. Using SPSS version 22, bivariate analysis and logistic regression analysis were used to analyse data. An independent factor associated with successful VBAC and with a p-value <0.05 was considered significant. Results. Of the participants, 236 (81.4%) had a successful vaginal delivery and 54 (18.6%) failed to deliver vaginally and required emergency CS. Key independent predictors of success of VBAC were primary education level (adjusted odds ratio (AOR) 2.21; 95% confidence interval (CI) 1.01 - 4.84), multiparity (AOR 4.81; 95% CI 1.16 - 19.93), previous successful VBAC (AOR 9.94; 95% CI 1.29 - 76.70), inter-delivery interval after the primary CS (AOR 18.54; 95% CI 5.98 - 57.48), a history of fetal distress (AOR 9.33; 95% CI 2.48 - 35.08), malpresentation (AOR 6.13; 95% CI 1.65 - 22.70) or failed induction of labour (AOR 20.52; 95% CI 3.32 - 127.03) as indications for the primary CS, Bishop score (AOR 7.06; 95% CI 1.92 - 25.97), cervical dilation (AOR 11.62; 95% CI 3.86 - 35.03), duration of labour (AOR 20.78; 95% CI 5.62 - 76.80), birthweight (AOR 6.80; 95% CI 3.33 - 13.91) and Apgar score (AOR 28.42; 95% CI 5.67 - 142.38). Conclusion. A combination of independent sociodemographic and obstetric factors that have significant high odds for a good outcome of VBAC could help predict success of delivery in a given population. This information could also aid in counselling mothers on mode of delivery.

Intersectional Inequities in Maternal Mortality: Examining the Compounded Risks for Black Birthing Individuals with Physical Disabilities

BackgroundPeople who are Black and have physical disabilities likely face a dual burden of risk for maternal mortality due to enduring systemic oppression rooted in racism and ableism. ObjectiveTo investigate maternal mortality risks among Black birthing individuals with physical disabilities in the United States and assess the potential compounding effect when these marginalized identities intersect. MethodsWe conducted a historical cohort study using the 2004-2021 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The study included 8,263,997 delivery hospitalizations. We used modified Poisson regression to estimate unadjusted and adjusted relative risks (RR) of maternal mortality by race and physical disability status. We calculated the Relative Excess Risk due to Interaction (RERI) and Attributable Proportion (AP) to assess additive interaction between Black race and physical disability status. ResultsAfter adjusting for covariates, compared to their White birthing individuals, their Black peers experienced about 2.5 times (RR=1.48,95%CI:2.08-2.96) the risk of maternal mortality. Compared to birthing individuals without physical disabilities, those with physical disabilities experienced nearly 11 times the (RR=10.72,95%CI:8.15-14.10) risk of maternal mortality. Our adjusted additive interaction analysis revealed a significant super-additive effect (RERI=11.3;AP=0.47); suggesting that the combined effect of having both marginalized identities was greater than the sum of the individual effects of each identity. ConclusionsOur findings provide evidence for substantial inequities in maternal mortality by Black race and physical disability status, with evidence of a compounding effect when these marginalized identities intersect. These results underscore the urgent need for intersectional approaches in maternal health interventions and policies.

Acute confusion in pregnancy

If a woman is acutely confused in pregnancy, she will most likely present to an unscheduled care setting outside of maternity services. It is therefore essential that all clinicians working within general medicine are comfortable assessing pregnant women in this context. Useful resources are available to support assessing pregnant women that present acutely, however confusion is beyond them. This article discusses important aspects to consider when assessing pregnant women and places emphasis on a systematic approach to ensure obstetric and non-obstetric causes of confusion have been considered. Certain life-threatening diagnosis’ have been further discussed in more detail (Wernicke's encephalopathy, hyponatreamia, hypercalcamia, acute fatty liver of pregnancy and thrombotic thrombocytopenia purpura). These conditions have been chosen as there is a significant risk of maternal mortality and morbidity as well as poor fetal outcomes if not recognised and treated early.

Relationship between Sociodemographics and Nutritional Intake of FE with the Incidence of Anemia in Pregnant Women in the Sukaraja Health Center Working Area, Bandar Lampung City in 2024

Anemia is an important factor associated with an increased risk of maternal and child mortality. because of its adverse effects on the mother and fetus during pregnancy. pregnant women are the group most susceptible to anemia. There are various factors that can cause anemia in pregnant women such as sociodemographics and nutritional status. Sociodemographic factors can increase the occurrence of anemia in pregnancy, which consists of age, education, family income and occupation. The purpose of this study was to determine the Relationship between Sociodemographics and Fe Nutrition Intake with the Incidence of Anemia in Pregnant Women in the Sukaraja Health Center Work Area, Bandar Lampung City in 2024. Type of Quantitative Research, the design used in this study is observational analytic with a cross-sectional approach. The population and sample in this study were all pregnant women with anemia recorded from January - May 2024, totaling 104 respondents. The sampling technique in this study was simple random sampling. Based on statistical tests, it is known that the p-value is 0.000 or p-value 0.05, which means that there is a relationship between sociodemographics and iron nutrient intake with the incidence of anemia in pregnant women in the Sukaraja Health Center Work Area, Bandar Lampung City in 2024. The results of this study are expected to be used as additional information to overcome the causes of anemia in pregnant women, namely sociodemographics and iron nutrient intake.

When pulmonary arterial hypertension and pregnancy meet: a multidisciplinary clinical experts review.

Pulmonary hypertension (PH) is a rare condition characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance, potentially leading to right ventricular failure. Pulmonary arterial hypertension (PAH) is the most common type of PH in women of childbearing age and, as per the modified World Health Organization (mWHO) classification of maternal cardiovascular risk, it falls into mWHO class IV and pregnancy is contraindicated. These patients face an exceptionally high risk of maternal mortality and morbidity, with estimated maternal cardiac event rates ranging from 40 to 100% during pregnancy, because physiological changes happening in pregnancy exacerbate the disorder. Despite these recommendations, there is a growing incidence of pregnancy among women with PAH. Early referral to specialized centers, personalized therapies and expert multidisciplinary care involving pulmonary hypertension specialists, obstetricians, critical care specialists, anesthesiologists, and neonatologists are crucial steps to ensure positive outcomes for both mother and fetus. This review aims to examine the current understanding of pregnancy in patients with PAH, drawing on the experience of our center in the multidisciplinary management of pregnant women with this condition. In particular, we want to focus the attention of clinicians on the following aspects: early referral of pregnant patients to specialized centers, detailed counseling on the implications of pregnancy, initiation of therapy in treatment-naive patients and potential adjustment of therapy in non-naive patients, periodic risk assessment, evaluation of the appropriate timing of delivery, multidisciplinary management of the most critical periods, which are delivery and the post-partum phase.

Layers of inequality: gender, medicalisation and obstetric violence in Ghana

BackgroundThis study explored how gender inequalities in health systems influence women’s experiences of obstetric violence in Ghana. Obstetric violence is recognised as a major public health concern and human rights violation. In particular, it reduces women’s trust and use of health facilities for childbirth, thereby increasing the risks of maternal and neonatal mortality. In Ghana, obstetric violence is pervasive and normalised; yet, little is known about the gendered dynamics of this phenomenon.MethodologyA qualitative study was conducted in eight public health facilities in Ghana. Specifically, semi-structured interviews were conducted with 30 midwives who work in the maternity units and 35 women who have utilised the obstetric services of the hospitals for childbirth. The midwives and women were selected using the purposive sampling technique. The transcripts of the interviews were coded using NVivo qualitative data analysis software and were thematically analysed. Secondary materials such as existing data on the medical profession in Ghana were utilised to complement the primary data.ResultsThe study revealed that there are huge structural inequalities that keep women at the lower cadres of the health system. Five major themes depicting how gender inequalities contribute to women’s experiences of obstetric violence emerged: gender inequality in the medical profession, unequally and heavily tasked, feminisation of midwifery, patriarchal pressures and ideologies, and gender insensitivity in resource provision. These inequalities impact the kind of care midwives provide, which is often characterised by mistreatment and abuse of women during childbirth. The study also discovered that patriarchal ideologies about women and their bodies lead to power and control in the delivery room and violence has become a major instrument of domination and control.ConclusionThe hierarchical structure of the healthcare profession puts the midwifery profession in a vulnerable position, with negative consequences for maternity care (obstetric violence). The study recommends that gender-responsive approaches that address structural inequalities in health systems, women’s empowerment over their bodies and male involvement in women’s reproductive care are crucial in dealing with obstetric violence in Ghana.

An Explainable Deep Learning-Enhanced IoMT Model for Effective Monitoring and Reduction of Maternal Mortality Risks

Maternal mortality (MM) is considered one of the major worldwide concerns. Despite the advances of artificial intelligence (AI) in healthcare, the lack of transparency in AI models leads to reluctance to adopt them. Employing explainable artificial intelligence (XAI) thus helps improve the transparency and effectiveness of AI-driven healthcare solutions. Accordingly, this article proposes a complete framework integrating an Internet of Medical Things (IoMT) architecture with an XAI-based deep learning model. The IoMT system continuously monitors pregnant women’s vital signs, while the XAI model analyzes the collected data to identify risk factors and generate actionable insights. Additionally, an efficient IoMT transmission model is developed to ensure reliable data transfer with the best-required system quality of service (QoS). Further analytics are performed on the data collected from different regions in a country to address high-risk cities. The experiments demonstrate the effectiveness of the proposed framework by achieving an accuracy of 80% for patients and 92.6% for regional risk prediction and providing interpretable explanations. The XAI-generated insights empower healthcare providers to make informed decisions and implement timely interventions. Furthermore, the IoMT transmission model ensures efficient and secure data transfer.

Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease.

To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD). This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications. Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%). CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.

Association between socioeconomic disadvantage and severe maternal morbidity and mortality in high-income countries: a systematic review

BackgroundSocioeconomic position (SEP) is among the most important determinants of variations in health outcomes. This systematic review aimed to summarise the association between socioeconomic disadvantage and the risk of severe...

Pregnancy complications and long-term risk of cardiovascular events in women with heart disease

Abstract Background/Introduction Women with congenital heart or acquired heart disease are at increased risk of atherosclerotic cardiovascular disease. Pregnancy complications are established risk factors for cardiovascular disease in the general population, but their prognostic value for cardiovascular outcomes in the population with congenital or acquired heart disease is unknown. Purpose To determine the frequency and prognostic value of pregnancy complications for the risk of cardiovascular outcomes in women with congenital or acquired heart disease. Methods This nationwide registry-based cohort study included women in Sweden with heart disease (pulmonary arterial hypertension, congenital heart disease or acquired valvular heart disease) with singleton births registered in the national Medical Birth Register between 1973 and 2014. Exposures of pregnancy complications (preeclampsia/gestational hypertension, preterm birth or birth of an infant small for gestational age) were collected from the Medical Birth Register, and cardiovascular outcomes (mortality and hospitalizations) from the Cause of Death Register and the National Inpatient Register. Cox regression models were performed with time-dependent covariates, to determine the possible prognostic value of the studied pregnancy complications for cardiovascular outcomes including atherosclerotic cardiovascular disease, heart failure and arrythmias after adjustment for major confounding including smoking and body mass index. Results Among the total of 2,134,239 women included from the Medical Birth Register, 2,554 women with 5,568 singleton births were affected by heart disease. Preeclampsia/gestational hypertension affected 5.8% of pregnancies, preterm birth 9.7%, and birth of an infant small for gestational age 2.8%. Preterm birth (adjusted HR 1.91 (95% CI 1.38-2.64)) was associated with an increased risk of maternal all-cause mortality. Preeclampsia/gestational hypertension (adjusted HR 1.64 (95% CI 1.18-2.29)) and preterm birth (adjusted HR 1.56 (95% CI 1.19-2.04)) were associated with an increased risk of hospitalizations for atherosclerotic cardiovascular disease. Conclusions Pregnancy complications were frequent in women with congenital or acquired heart disease. With a median follow-up time of 22 years, preterm birth was associated with a higher risk of cardiovascular mortality, and preeclampsia/gestational hypertension and preterm birth were associated with cardiovascular morbidity. In women with heart disease, pregnancy complications may provide additional information for the risk assessment of future cardiovascular outcomes.Overview of study designPrevalence and risk estimation

Worse ischemic symptoms and cardiac function in women with suspected ischemia with no obstructive coronary artery disease and adverse pregnancy outcomes history

Abstract Background Adverse pregnancy outcomes (APO) are associated with increased maternal risk of cardiovascular disease (CVD) and mortality. Ischemia with no obstructive coronary artery disease (INOCA) is predominant in women, however the association of APO history with INOCA is poorly understood. Purpose To compare clinical characteristics, symptoms, cardiac structure and function and coronary microvascular dysfunction in women suspected to have INOCA with or without a history of APO. Methods Women’s Ischemia Syndrome Evaluation (WISE) CVD (NCT00832702) and WISE pre-HFpEF (NCT02582021) prospective cohorts of women with suspected INOCA were merged and utilized to determine among women with at least 1 prior pregnancy whether a history of APO was associated with ischemic symptoms, and to characterize CMRI measured left ventricle (LV) structure and function, myocardial deformation (systolic and diastolic strain) and coronary microvascular dysfunction on invasive coronary functional testing (CFT). Self-reported APO was defined as hypertensive disorder of pregnancy (HDP), gestational diabetes, preterm birth (<37-week gestation), low birth weight (<5lbs). Results In a cohort of 469 women with suspected INOCA, (mean average age 55 [SD 10.2] years) and at least 1 prior pregnancy, 138 (29%) had history of at least 1 APO. Among women with history of APO, 78 reported HDP, 50 gestational diabetes, 27 pre-term birth, 8 low birth weight. Women with a history of APO were younger, had higher rates of hypertension and diabetes, higher BMI and lower SAQ and DASI scores compared to those with no history of APO (Table). LV ejection fraction (EF) was lower and early diastolic strain rate/LVEDP was higher in women with APO history compared to those without APO history. Conclusion(s) In cohort of women with INOCA, history of APO was highly prevalent. Despite younger age, women with history of APO had higher rates of CVD risk factors, worse ischemic symptoms and functional capacity, lower EF, and higher filling pressures. Our findings suggest a potential for APO history to better identify women with worse prognosis that warrants further investigation and aggressive management.

Perceptions of Rural Access to Prenatal Care in the United States by Patients, Nurses, Midwives, and Physicians: An Integrative Review.

Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes. This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists. Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access. Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.

Double burden of gestational diabetes and pregnancy-induced hypertension in Ethiopia: A systematic review and meta-analysis of observational studies.

The coexistence of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) amplifies the risk of maternal and perinatal mortality and complications, leading to more severe adverse pregnancy outcomes. This systematic review and meta-analysis aimed to assess the double burden of GDM and PIH (GDM/PIH) among pregnant women in Ethiopia. A comprehensive systematic search was conducted in the databases of PubMed, Cochrane Library, Science Direct, Embase, and Google Scholar, covering studies published up to May 14, 2023. The analysis was carried out using JBI SUMARI and STATA version 17. Subgroup analyses were computed to demonstrate heterogeneity. A sensitivity analysis was performed to examine the impact of a single study on the overall estimate. Publication bias was assessed through inspection of the funnel plot and statistically using Egger's regression test. Of 168 retrieved studies, 15 with a total of 6391 participants were deemed eligible. The pooled prevalence of GDM/PIH co-occurrence among pregnant women in Ethiopia was 3.76% (95% CI; 3.29-4.24). No publication bias was reported, and sensitivity analysis suggested that excluded studies did not significantly alter the pooled prevalence of GDM/PIH co-occurrence. A statistically significant association between GDM and PIH was observed, with pregnant women with GDM being three times more likely to develop PIH compared to those without GDM (OR = 3.44; 95% CI; 2.15-5.53). This systematic review and meta-analysis revealed a high dual burden of GDM and PIH among pregnant women in Ethiopia, with a significant association between the two morbidities. These findings emphasize the critical need for comprehensive antenatal care programs in Ethiopia to adequately address and monitor both GDM and PIH for improved maternal and perinatal health outcomes.

The Relationship Between Age and The Incidence of Post Dural Puncture Headache in Post Sectio Caesarea Patients with Spinal Anesthesia

Background: Caesarean Section (CS) is a surgical procedure involving incisions in the abdominal wall and uterus. Spinal anesthesia is the preferred method due to the lower maternal morbidity and mortality risks compared to general anesthesia. However, the most common complication associated with spinal anesthesia is Post Dural Puncture Headache (PDPH), caused by a dural puncture. Age is a significant factor influencing PDPH occurrence. Patients aged 20-40 are at a higher risk, while those over 50 years have a reduced risk due to the decrease in cranial elasticity and pain sensitivity with age. Purpose: This study aims to assess the correlation between age and the incidence of PDPH following spinal anesthesia in CS patients. Methods: This study employed a cross-sectional analytic correlation design. The sample included all CS patients who received spinal anesthesia and met the study criteria, totaling 35 respondents. Data were analyzed using univariate and bivariate analysis, with the correlation significance tested at 0.05 (2-tailed). Findings: The study revealed that 14.3% of respondents experienced PDPH, while 85.7% did not. A significant correlation was found between age and PDPH incidence, with a p-value of 0.05. The highest incidence of PDPH was observed in the 20-40 age group, decreasing notably in individuals aged 50 and above. Conclusion: This study highlights that PDPH risk is highest in patients aged 20-40 and significantly decreases in patients older than 50. Age-related changes in cranial structure and pain sensitivity likely contribute to this decreased risk.

Barriers to Reproductive Justice for Women Seeking Sanctuary in the UK: Narratives from Birth Companions and the Maternity Stream of Sanctuary

Women living in the UK with insecure immigration status are often from ethnic minority groups, have limited understanding of English, and have significant experience of trauma. Recent confidential inquiries into maternal deaths have repeatedly shown how intersecting and multiple disadvantage puts these women at higher risk of maternal mortality and morbidity. Multiple voluntary sector organisations are relied upon to support these women as they navigate the journey to parenthood. A reproductive justice framework is here employed to examine the multitude of factors intersecting to influence the access women with insecure migrant status have to maternity services. Narrative construction of three composite case studies took place to highlight the various ways reproductive justice is both violated and protected by the immigration and maternity systems in the UK. The discussion section comments on prevalent themes throughout each case study: gendered dynamics of insecure immigration status, structural barriers and complex systems, and reliance on the fragile voluntary sector. This article concludes that, alongside the work of the voluntary sector, women’s reproductive justice rights must also be emphasised and protected throughout statutory systems and services.

Listening to the Perspectives of Black Women on Perinatal Health Disparities: Reversing the Tide and Improving Outcomes.

Pregnancy-related health in the USA fares worse than similarly resourced countries and the gap continues to widen. This trend however is disproportionately experienced by women of color. We have come to understand that this is due to the systems and structures that perpetuate racism. Despite our awareness of this, the voices of the community impacted by these systems have been largely left out of research. The authors aimed to utilize participatory research methods within a qualitative design to askBlack pregnant and parenting women about their lived experiences of pregnancy and perinatal health services. Over three focus groups, the authors gathered information from 12 participants. Participants were Black women currently pregnant or pregnant in the last year, ages 22-37years old. Participants shared their experiences and views on racial disparities within perinatal health care. Our analytic goal was to explore the questions: "What are Black women talking about in relation to perinatal health"; "Where do Black women get information about perinatal health disparities?"; and "How do Black women feel when they hear or talk about perinatal health risks?". In general, participants felt that the burden to understand their pregnancy risks and options was theirs alone to carry. This resulted in their utilization of and reliance on the internet, social supports, and holistic providers such as doulas for information about how to reduce their risk for maternal morbidity and mortality. Results demonstrate patients' receptivity to frank conversation about perinatal health disparities, and their willingness to partner with their providers to reduce risks in pregnancy. While interventions to reduce perinatal health risks must be systemic, they cannot move forward without including the voices of and partnering with the community they hope to positively impact.

Pregnancy complications and long-term risk of cardiovascular events in women with structural heart disease

BackgroundTo determine the frequency of pregnancy complications and their association with the risk of cardiovascular outcomes in women with structural heart disease (SHD).MethodsThis nationwide registry-based cohort study included women in...

Abstract P412: Pulmonary Hypertension in Patients with Preeclampsia: Prevalence, Predictors and Associated In-Hospital Adverse Events

Pulmonary hypertension (PH) is prevalent pregnant women, but there is a lack of research into its co-occurence with preeclampsia. Our study aimed to characterize and evaluate the real-world prevalence, predictors and outcomes of PH in preeclamptic patients Data were obtained from the National Inpatient Sample database from 2016 to 2019.Primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with preeclampsia with or without PH, outcomes for preeclamptic patients with PH, and predictors of mortality. Of 255,513 preeclamptic patients, 497 (.194%) developed PH. Patients with PH had a significantly elevated likelihood of having IDA (9.7% vs 2.6%, p<.001), CHF (25.5% vs 0.4%, p<.001), pulmonary disease (17.7% vs 7.6%, p<.001), coagulopathy (2.0% vs 0.8%, p=.002), T2DM (7.2% vs 2.8%, p<.001), hypertension (0.8% vs 0.3%, p=.014), alcohol abuse (1.4% vs 0.1%, p<.001), liver disease (2.0% vs 0.4%, p<.001), atrial fibrillation (0.6% vs 0.1%, p<.001), hypothyroidism (7.0% vs 4.6%, p=.01), CAD (1.8% vs 0.1%, p<.001), OSA (8.7% vs 0.7%, p<.001), opioid use (1.8% vs 0.9%, p=.026), obesity (33.2% vs 19.4%, p<.001), and ESRD (0.8% vs 0.0%, p<.001). Univariate analysis showed that PH in preeclamptic patients was associated with higher rates of cardiac arrest (0.8% vs 0.0% p<.001), permanent pacemaker (1.4% vs 0.1% p<.001), ventricular fibrillation (0.2% vs 0.0% p<.001), angioplasty (0.8% vs 0.0% p<.001), PE (1.0% vs 0.0% p<.001), shock after delivery (1.2% vs 0.1% p<.001), PPH (10.1% vs 7.3% p=.017), right heart catheterization (2.0% vs 0.0% p<.001), left heart catheterization (0.6% vs 0.0% p<.001), cardiogenic shock (1.0% vs 0.0% p<.001), medical ventilation (3.6% vs 0.1% p<.001), vasopressor use (1.2% vs 0.1%, p<.001), STEMI (0.2% vs 0.0%, p<.001), and NSTEMI (1.2% vs 0.0% p<.001). Predictors of mortality included age at admission (OR 1.06, 95% CI 1.0–1.1, p<.05), Asian and Pacific Islander race (OR 4.89, 95% CI 1.9–12.7 p<0.05), CHF (OR 19.41 , 95% CI –, p<.05), coagulopathy (OR 19.4, 95% CI 6.4–58.8 p<.05), liver disease (OR 6.5, 95% CI 2.0–21.3 p<.05), eclampsia (OR 17.3, 95% CI 5.3–55.9 p<.05), and HELLP syndrome (OR 6.2, 95% CI 2.8–13.5 p<.05). PH in preeclampsia is associated with an increased risk of maternal mortality, heart failure, arrhythmia, pulmonary embolism. The present study found age at admission, AAPI race, CHF, coagulopathy, liver disease, eclampsia, and HELLP syndrome to be predictors of mortality.

Factors associated with postnatal care utilization in Afghanistan

Afghanistan has one of the highest maternal mortality rates in the world. Inadequate postnatal care (PNC) increases the risk of maternal mortality. This study aimed to analyze the socioeconomic and demographic factors that affect postnatal care utilization. A secondary analysis was conducted in 2019 based on the data from the 2015 Afghanistan Demographic and Health Survey. The sample included 29,461 married women aged 15–49 interviewed during the survey. This was a cross-sectional study in which a frequency distribution of independent variables for the study sample was carried out, Pearson’s chi-square test was conducted for association, and the strength of association was measured using binary logistic regression. The study found that 39.9% of married women used postnatal care services. The findings of this study suggest that place of delivery and women who gave birth at health facilities were more likely to use PNC than women who delivered at home. Women age 30–39 and 20–29 positively associated with PNC use compared with mothers aged < 20 years. Each level of women’s educational attainment increased their use of PNC, and women with higher education were more likely to use PNC than those without education. Furthermore, women who visited 1–3 and more than four ANC visits were more likely to use PNC than women who did not visited ANC. Moreover, women exposed to mass media were more likely to use PNC than those who were not exposed to mass media. Finally, women who lived in the northern and western regions were more likely to use PNC than those who lived in the central region, while women who lived in the southern and southeastern regions were less likely to use PNC than those who lived in the central region. Therefore, strengthening the provision of information, education, and communication could be a communication channel to further improve PNC utilization. Meanwhile further studies are needed to focus on the quality of maternal health care and PNC services in Afghanistan in order to obtain more precise information.