Risk Of Maternal Death Research Articles

Perceptions of Postpartum Teaching and Knowledge of Warning Signs among Black Mothers.

The postpartum period is the time of highest risk for maternal death. Quality postpartum education is important to minimize risk. We assessed the postpartum education given to Black mothers on post-birth warning signs by conducting a cross-sectional survey of 80 Black women who had given birth in the previous 12 months. Participants completed an electronic questionnaire, and data were analyzed using descriptive and regression models. On average, educational needs were reported by 20 participants as being unmet, 27 as being met, and 30 as being more than met. Only 54.4% of the participants reported receiving education about postpartum warning signs. The percentage of participants able to identify each sign ranged from 11.4% to 35.4%. No participants identified more than five of the nine warning signs, and 25% identified none. Knowledge of post-birth warning signs was significantly associated with the delivery hospital, household income, and education on warning signs before discharge.

Robotic-Assisted Laparoscopic Resection of a Cornual Ectopic Pregnancy: Video Presentation

Study Objective A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Design Case Report. Setting Tertiary care center outside of a major city in the United States. Patients or Participants We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. Interventions The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. Measurements and Main Results The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Conclusion Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss. A cornual ectopic pregnancy is a pregnancy that implants in the cornua, the most proximal portion of the fallopian tube lying within the myometrium. Cornual ectopics comprise only 2-3% of cases of ectopic pregnancy, however, they have a significantly higher risk of maternal death, at 2-2.5%. This is due to the abundant blood supply to the cornua from both uterine and ovarian vessels leading to greater risk of hemorrhage and hypovolemic shock. This video demonstrates how a cornual ectopic pregnancy can be treated using minimally invasive technique with minimal blood loss. We also explore the use of vasopressin as an adjunct in surgery to minimize blood loss. Case Report. Tertiary care center outside of a major city in the United States. We present a case of a 24-year-old G3P1011 at 7 weeks gestation by last menstrual period who presented to the Emergency Department with severe left lower quadrant pain for 1 day. She was found to have a cornual ectopic pregnancy. The cornual ectopic was treated by robotic-assisted laparoscopy. Her treatment was further enhanced by the use of dilute vasopression injected into the cervix and the cornua. The ectopic was dissected using monopolar scissors and removed from the uterus intact. The defect in the uterus was closed with a barbed suture. The entire procedure took 50 minutes with an estimated blood loss of less than 10cc. Postoperative course was uncomplicated with a negative bhCG at follow-up on postoperative day 27. Robotic-assisted laparoscopy is a safe and effective approach for resection of cornual ectopic pregnancies. Vasopressin can be used as an adjunct to minimize blood loss. Future research should continue to explore minimally invasive techniques for cornual ectopic resection, focusing on the use of adjunct procedures and medications to reduce surgical time and minimize blood loss.

Society for Maternal-Fetal Medicine Special Statement: A quality metric for evaluating timely treatment of severe hypertension

Severe hypertension in pregnancy is a medical emergency. Although expeditious treatment within 30 to 60 minutes is recommended to reduce the risk of maternal death or severe morbidity, treatment is often delayed by >1 hour. In this statement, we propose a quality metric that facilities can use to track their rates of timely treatment of severe hypertension. We encourage facilities to adopt this metric so that future reports from different facilities will be based on a uniform definition of timely treatment.

Prediksi Pencapaian Target Peserta Keluarga Berencana Pasca Persalinan Menggunakan Algoritma Backpropagation

Population growth in Indonesia continues to increase, so the government makes a program to control the rate of growth of the population, namely the Family Planning Program (KB). The implementation of family planning also has another objective, namely to reduce the risk of maternal death after childbirth. To measure the level of increasing target achievement of postpartum family planning participants. So that it can be a reference for the DPPKBP3A in carrying out the postpartum family planning program. Data from the Population Control, Family Planning, Women Empowerment and Child Protection (DPPKBP3A) District Lima Puluh Kota data processed in this study is data on the achievement of postpartum family planning participants from 2018 to 2020. Data processing uses the Backpropagation algorithm through several stages, namely the stage initialization, activation stage, weight training (weight change) and iteration stage. One of the results obtained from the calculation is the comparison of the target with the output gradient error in Suliki District in 2018, namely the target of 0.11311 and the result of the error gradient output is -0.1171. The prediction results obtained from this process become a reference for the Population Control, Family Planning and Women Empowerment and Child Protection Agency (DPPKBP3A) of District Lima Puluh Kota to implement the implementation of postpartum family planning programs to the community the following year.

Trends in maternal mortality in India over two decades in nationally representative surveys.

ObjectiveTo assess national and regional trends and causes‐specific distribution of maternal mortality in India.DesignNationally representative cross‐sectional surveys.SettingAll of India from 1997 to 2020.SampleAbout 10 000 maternal deaths among 4.3 million live births over two decades.MethodsWe analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15–49 years) and live birth totals, based on the 2001–2014 Million Death Study to United Nations (UN) demographic totals for the country.Main outcome measuresMaternal mortality burden and distribution of causes.ResultsThe MMR declined in India by about 70% from 398/100 000 live births (95% CI 378–417) in 1997–98 to 99/100 000 (90–108) in 2020. About 1.30 million (95% CI 1.26–1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700–26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20–29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India’s 2016–2018 estimate of 113 (95% CI 103–123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north‐eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy‐related infection (12%) and hypertensive disorders of pregnancy (7%).ConclusionsIndia could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.Tweetable abstractWe estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Is it time to start COVID-19 vaccination in pregnant women?

HIGHLIGHTS1. Pregnant women infected with COVID 19 have a higher risk of maternal fetal mortality and morbidity.2. The available evidences show a safety profile in all type of COVID vaccines in pregnancy.3. Vaccination in pregnant women will decrease pregnancy complications, adverse pregnancy outcomes, and maternal death risk.4. The benefit of COVID vaccination exceeds the potential risk in pregnant women.5. Pregnant women are strongly recommended to receive COVID vaccine. ABSTRACTCOVID-19 pandemic has been lasting for years, and pregnant women encounter an increased risk of mortality and morbidity. Until now, vaccine COVID-19 has been developed and shows a promising result. Unfortunately, pregnant women are consistently excluded from receiving a new vaccine. Because pregnant women are excluded from participating in a clinical trial of vaccines related to safety issues, this exclusion cycle prevents pregnant women from receiving the vaccine that may benefit them. In this review article, the author provides evidence, data, and the reason why vaccination of pregnant women should be started in Indonesia, at least in a clinical trial, especially for health workers and women with comorbidities.

Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study

BackgroundDetailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health. MethodsThis was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities’ risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19. FindingsA total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0.10; P = 0.010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19. InterpretationIn Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators. FundingNone

Prediksi Pencapaian Target Peserta Keluarga Berencana Pasca Persalinan menggunakan Algoritma Backpropagation

Population growth in Indonesia continues to increase, so the government makes a program to control the rate of growth of the population, namely the Family Planning Program (KB). The implementation of family planning also has another objective, namely to reduce the risk of maternal death after childbirth. To measure the level of increasing target achievement of postpartum family planning participants. So that it can be a reference for the DPPKBP3A in carrying out the postpartum family planning program. Data from the Population Control, Family Planning, Women Empowerment and Child Protection (DPPKBP3A) District Lima Puluh Kota data processed in this study is data on the achievement of postpartum family planning participants from 2018 to 2020. Data processing uses the Backpropagation algorithm through several stages, namely the stage initialization, activation stage, weight training (weight change) and iteration stage. One of the results obtained from the calculation is the comparison of the target with the output gradient error in Suliki District in 2018, namely the target of 0.11311 and the result of the error gradient output is -0.1171. The prediction results obtained from this process become a reference for the Population Control, Family Planning and Women Empowerment and Child Protection Agency (DPPKBP3A) of District Lima Puluh Kota to implement the implementation of postpartum family planning programs to the community the following year.

Assessing the maternal risks associated with short stature in ancient Southeast Asia

AbstractThe maternal experience in ancient Southeast Asia has been an area of study not yet addressed in bioarchaeological research due to the challenges associated with evaluating it and the lack of tools available. This study aims to better our knowledge of the maternal experience in ancient Southeast Asia by investigating whether there is a relationship between maternal mortality rates and a known maternal risk factor, stature, which can be estimated from archaeologically derived skeletal remains. This is performed by applying an adapted maternal mortality rate estimator and undertaking analyses based on stature estimates from ancient Southeast Asian archaeological samples. By investigating estimated stature and maternal mortality rates, we are able to look at whether the modern risks associated with pregnancy in short statured females were also seemingly applicable in the past in Southeast Asia. This study identified that, at the population level, a decrease in average stature coincided with an increase in maternal mortality rates. These results emulate modern trends, with shorter statured females being at a higher risk of maternal death and often requiring medical intervention due to complications caused by their short stature and associated small pelvis. These findings contribute to our understanding of the maternal risk associated with short stature in ancient Southeast Asia.

Spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia: a spatial and multilevel analysis

BackgroundMaternal anemia continues as a global public health concern particularly in developing countries including Ethiopia. It is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. Even though maternal anemia is the commonest problem in Ethiopia, there is limited evidence on the spatial distribution and determinants of iron supplementation. Therefore, this study aimed to investigate the spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia.MethodA secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 7589 women was included for analysis. For the spatial analysis; ArcGIS version 10.6, and SaT Scan version 9.6 statistical software were employed to explore the spatial distribution, and to identify significant hotspot areas of iron supplementation in Ethiopia. For the determinant factors, multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Deviance, Median Odds Ratio (MOR), and Intra-class Correlation Coefficient (ICC) were used for model comparison and for assessing model fitness. Variables with a p-value of less than 0.2 in the bivariable analysis were considered in the multivariable multilevel analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare significant determinants of iron supplementation.ResultsThe spatial distribution of iron supplementation was significantly varied across the country with Global Moran’s index value of 0.3 (p < 0.001). The SaTScan analysis identified a total of 271 significant clusters, of these 89 clusters were primary clusters located in the Southwest Somali and Central Oromia regions (LLR = 66.69, P < 0.001, RR = 1.35). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were statistically significant determinant factors of iron supplementation.ConclusionIron supplementation among pregnant women were significantly varied across the country. Therefore, the finding of this study could help to design effective public health interventions targeting areas with low iron supplementation and maternal health services should be delivered in all areas of our country. Besides, public health programs should enhance iron supplementation through promoting ANC visits, media exposure, and giving special emphasis to marginalized and remote areas.

Primary healthcare services and maternal mortality in Ugep

This paper focusses on pregnancy related deaths which is a contemporary issue in modern day Nigeria. Maternal Mortality is more pronounced in Ugep, Cross River State with the maternal mortality ratio of l200/100,000 which is higher than the national figure of 1100/100,000 (Nigerian Partnership for Safe Motherhood, 2018). In Nigeria, about 75 % of women die as a result of these complications either during the course of giving birth or the week preceding delivery (Choudhry, 2012). Recent statistics shows that Maternal deaths account for 32% of all deaths among women age 15–49 in Nigeria. The maternal mortality rate for the seven-year period preceding NDHS 2013 survey was 1.05 maternal deaths per 1000 women. The maternal mortality ratio was 576 maternal deaths per 100,000 live births. The lifetime risk of maternal death indicates that out of every 30 women in Nigeria, one will have a death related to pregnancy or childbearing (NDHS, 2013). Statistics further revealed that pregnancy complications in 2012 led to the death of over 52,000 women in Nigeria (Dada, 2016). Maternal Mortality in the seven years preceding the National Demographic Health Survey in 2013 records the figure of live births to be 575 per 100,000, which implies that for one single pregnancy complications resulting to death, more than 20 others are confronted with disabilities which may last a life time, (NDHS, 2013). The theoretical application combines aspects of the Environmental Precedence Theory, Rational Choice Theory and the Health Belief Model (HBM) to explain core variables of the relationship between maternal health practices and pregnancy outcomes. Several conclusions were inferred from the application of sociological theories to the chosen contemporary issue.

Home Deliveries in Rwinkwavu District Hospital, Rwanda: Factor Associated with Recurrence of the Practice

Home delivery is persisting in developing countries. In Rwanda, 9% of mothers derived at home as reported in 2015 Demographic Health Survey. Delivering at home is associated with higher risk of maternal deaths. This study aims to investigate the rates of home delivery and associated factors. This study was a cross sectional study design with both qualitative and quantitative approaches. A convenience sampling was used to select 160 mothers for quantitative data. For qualitative data, 16 FGDs were conducted. Data were collected by using a structured questionnaire and interview guide. Quantitative data was analyzed using SPSS while qualitative data were thematically analyzed. A total of 160 mothers from 8 sectors of Kayonza district participated in the study. Of them 61.3% were aged less than 35 years, 70% were married, and 93.8% had attended primary education. The rate of delivering at home was 36.9% (deliver at home for two times or more). We found that mothers aged over 35 years were 3.5 times more likely to recurrently deliver at home than mothers aged between 15-35 years (OR=3.5; 95% CI: [1.80-6.96]; p&lt;0.001). The odds of having a recurrence of home delivery was found to be 4 times higher among mothers with limited transport facilitation (OR=4.0; 95% CI: [1.01- 16.1]; p=0.047). Poverty, family conflicts, increase of teenage pregnancies, lack of health insurance, a lack of money to pay for a hospital services were mentioned as factors influencing recurrence of home delivery. There is a need to increase the support received by poor families in Rwanda.

Zero-Inflated Models for Count Data: An Application to Number of Antenatal Care Service Visits

The risk of maternal death in developing countries is projected to be one in 61, while for developed countries it is estimated to be one in 2800. Antenatal care is a protective obstetric health care system aimed at improving the outcome of the pregnant fetus by routine pregnancy monitoring. One of the most important functions of antenatal care is to offer health information and services that can significantly improve the health of women and their infants. 6450 pregnant women from Ethiopian Demographic and Health Survey of 2016 were used to analyze the determinants of the barriers in number of antenatal care service visits among pregnant women in Ethiopia. The data were found to have excess zeros (35%); thus several count data models such as Poisson, Negative Binomial, Zero Inflated Poisson, Zero Inflated Negative Binomial and Hurdle regression models were modeled and fitted. From the exploratory analysis the results showed that among those eligible pregnant women, it was seen that 2240 (34.7%) of them did not visit antenatal care service during their periods of pregnancy months. The visualization of data using scatter plot depicts that all of the variables selected for modeling have an influence on the event of not visiting antenatal care cervices while each of these variables had opposite slope in non-zero number of such events in their respective categories. To select the model which best fits the data, models were compared based on their Akaike information criterion value by using the simulation study. The simulation experiment revealed that models for zero-inflated data such as; Zero Inflated Poisson, Zero Inflated Negative Binomial and Hurdle were models that fitted the data better than the classical models Poisson and Negative Binomial. Each of these zero-inflated models was compared using Voung test and Hurdle model was better fitted the data which was characterized by excess zeros and high variability in the non-zero outcome than any other zero-inflated models. In this study, maternal education, partner education level, age of mothers, religion of mothers and wealth index are major predictors of antenatal care service utilization. Through simulation experiment, it was found that Zero Inflated Poisson, Zero Inflated Negative Binomial and Hurdle models were better fitted zero-inflated data than Poisson and Negative Binomial. Voung test suggests that Hurdle model was better fitted zero-inflated (ZI) data than any other zero inflated models and therefore, it was selected as the best parsimonious model.

ANTENATAL CARE VISIT COMPLIANCE IN THE TANJUNG BERLIAN HEALTH CENTER WORK AREA

Background : Non-compliance in prenatal care can cause the mother's complications to be unrecognized which may affect pregnancy or pregnancy complications so that they cannot be resolved immediately. Detection during antenatal care is very helpful in preparation for risk control (Manuaba, 2007). Moreover, pregnant women who do not perform antenatal care, it will not be known whether the pregnancy is going well or experiencing high risk conditions and obstetric complications that can endanger the life of the mother and her fetus. And it can cause high morbidity and mortality (Prawiroharjo, 2008). One of the factors that influence the high maternal mortality rate is the attitude and behavior of the mother herself during pregnancy and is supported by the mother's knowledge of her pregnancy. Some of the factors behind the risk of maternal death are the lack of community participation due to the low level of maternal education, low family economic capacity, and unsupportive socio-cultural position. If taken further, some of these unsupportive behaviors can also carry risks. Other factors such as maternal age at pregnancy and childbirth, mothers who are too young (less than 20 years) and too old (over 35 years), frequency of births having given birth four times or more and spacing between births or deliveries of less than 24 months, including groups that are at high risk and increase the chance of maternal death are getting bigger (Erina, 2012). Research Objectives Knowing the Compliance of Antenatal Care Visits in the Tanjung Berlian Public Health Center. Method :This research uses descriptive study. The population used in this study were all pregnant women in the 3rd trimester in the Tanjung Berlian Public Health Center, totaling 206 people. The sampling method was taken using purposive sampling technique, which is purposive sampling in accordance with the required sample requirements / criteria

Latent iron deficiency and iron deficiency anemia in pregnancy: effects on maternal and fetal health, possible ways to solve the problem

Iron deficiency with or without anemia in pregnant women is quite common today. In fact, anemia affects nearly 30% of women of reproductive age, and its prevalence among pregnant women is estimated to be 38% worldwide. Although iron deficiency (IR) is not the only cause of anemia, it is the most prevalent one. Anemia-reduction strategies among pregnant women are often ineffective, and severe anemia can greatly increase the risk of maternal mortality, as reported by WHO. Now therefore, the current guidelines for screening and treatment of ID-anemia (IDA) in pregnant women and new-borns require change. Severe anemia can greatly increase the risk of maternal death and adversely affect a developing fetus and new-born. In this review, we analyse the available data on the epidemiology and the effects of iron deficiency on mothers and infants, current treatment strategies and screening recommendations, as well as examine the treatment of IDA in pregnant women and newborns and the problem of poor compliance in patients with latent iron deficiency. A continuous long-term course of administration of oral iron supplements is one of the components of success in the treatment of IDA, and particularly latent forms of iron deficiency in pregnant women. It is often the case that poor patients’ compliance with therapy leads to poor treatment outcomes and misleading conclusions about the ineffectiveness of oral iron dosage forms in the battle against IDA. The data we have analysed suggest the possibility of increasing compliance with IDA treatment in pregnant women.

Pelatihan Pengodean Tindakan Medis Berdasarkan ICD 9-CM pada Kasus Obstetri dan Ginekologi di RSIA Sayang Ibu Batusangkar

The risk of maternal death in developing countries is 33 times greater than in developed countries. The majority of countries around the world use ICD as a guide for recording, coding, tabulating, and reporting mortality statistics. To improve the accuracy of recording, classification of diseases and medical procedures, a community service related to coding of medical procedures was carried out at RSIA Sayang Ibu Batusangkar. This community service activity was held during the Covid- 19 pandemic, so the implementation was carried out through the Zoom application. In this community service activity, in general the participants have been able to codify obstetric and gynecological procedures well, only need to increase the coding of complications cases. It is hoped that after this training, all participants can improve their abilities in understanding and coding obstetric and gynecological actions in the hospital.

Risk factors of maternal death in preeclampsia

Aim. To determine the factors contributing to maternal death due to preeclampsia.Materials and Methods. We performed a retrospective study of 149 maternal deaths from preeclampsia during 2013-2017, which included the analysis of birth histories, medical records, individual observation cards, outpatient records, and questionnaires of healthcare workers and relatives.Results. Preeclampsia was responsible for 24.1% of maternal deaths over 5 years (2013-2017). The causes of death in women with preeclampsia were: pulmonary oedema (33/149, 22.2% cases), acute renal failure (33/149, 22.2%), cerebral complications (43/149, 28.6%), and hepatic impairment (acute fatty liver of pregnancy or HELLP syndrome, 45/149, 30.2%). The majority of pregnant women admitted in critical condition because of acute fatty liver of pregnancy or HELLP syndrome (45/149, 30.2%), eclampsia at home (25/149, 16.8%), or severe hypertension (114/149, 76.5%). The majority of those who died from preeclampsia had premature births (86/149, 57.7%) and delivered by caesarean section (117, 78.5%), yet the latter was associated with a higher risk of maternal death in case of preeclampsia (OR = 30.028. 95% CI = 15.277-59.022) as compared with vaginal delivery. Risk factors of the maternal death in preeclampsia included late hospitalization (66% of deaths), inadequate antenatal care (64.4%), incorrect route of examination and hospitalization (31.6%), underestimation of the patient's condition (42.3 %), insufficient monitoring during pregnancy, childbirth and post childbirth (48.8%), and insufficient teamwork of medical staff (42.2%).Conclusions. Insufficient knowledge of preeclampsia symptoms by pregnant women and their families, insufficient monitoring of blood pressure, underestimation of organ dysfunction, late hospital admission, late delivery, insufficient antihypertensive therapy, delivery at elevated blood pressure, and insufficient teamwork of healthcare professionals increase the risk of maternal mortality in the patients with preeclampsia.

Effect of hypofibrinogenemia on obstetrical disseminated intravascular coagulation in Japan in 2018: a multicenter retrospective cohort study.

Japanese obstetrical hemorrhage recommendations state that not only pregnant women with an obstetrical disseminated intravascular coagulation (DIC) score ≥ 8 points but also those with fibrinogen levels ≤ 1.5g/L have a high risk of maternal death and warrant blood transfusion. Our aim was to demonstrate the potential of fibrinogen levels ≤ 1.5g/L as predictors of a Japanese obstetrical DIC score of ≥ 8. We included 595 participants with blood loss ≥ 1000mL during vaginal delivery or ≥ 2000mL during cesarean delivery. The frequency and volume of red blood cell (RBC), fresh-frozen plasma, platelet concentrate (PC), and fibrinogen administration in women with a DIC score of ≥ 8 and fibrinogen levels of ≤ 1.5g/L were significantly higher than controls (P < 0.0001). Multivariate analysis demonstrated that a score of ≥ 3 was associated with RBC or fibrinogen administration and a score of ≥ 5 was associated with PC transfusion. Fibrinogen levels ≤ 1.89g/L and ≤ 2.44g/L were associated with PC transfusion and fibrinogen administration, respectively. Fibrinogen levels ≤ 1.5g/L may have similar potential to a DIC score of ≥ 8 points for detecting obstetrical DIC in Japan.

1162 Relationship of maternal-fetal medicine specialist density with maternal mortality ratios between 2010 and 2018

With the increase in maternal mortality and morbidity in the United States, it is imperative to understand what aspect Maternal-Fetal Medicine provider density has on this. Our study’s objective was to determine the relationship between state-specific maternal mortality ratios and the density of Maternal-Fetal Medicine specialists. State maternal mortality ratios from 2010 to 2018 were calculated from the Centers for Disease Control National Center for Health Statistics database (Maternal mortality defined as maternal deaths within a year following pregnancy). Practitioner distribution data were obtained from professional associations and national provider information. Demographic information regarding states was gathered from the yearly American Community Survey (ACS). Bivariable and multivariable analyses were conducted with the use of Spearman correlations and Poisson regression, respectively. Our primary outcome was a measure of maternal mortality ratios correlated with Maternal-Fetal Medicine physician density. The median state maternal-mortality ratio was 17.4/100,000 live births (increased significantly from 7.5/100,000 livebirths for years 1994-2001). Our study showed that an increase of 4 maternal-fetal specialists per 10,000 live births results in a 20% reduction in the risk of maternal death (relative risk [RR] =0.63, 95% CI = 0.31- 0.81, p = 0.04). This risk reduction was based on a multivariable Poisson regression model that included the following variables and their significant interactions: state-specific percentages of mothers in poverty, mothers without a high school diploma and minority mothers. The maternal mortality rate has significantly increased over the last 10 years, even doubling when compared to a prior analysis done in 2001. The density of maternal-fetal medicine specialists is significantly and inversely associated with maternal mortality ratios, even after controlling for state-level measures of maternal poverty, education, race, age, and their significant interactions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of the effect of education on perceived stress of mother candidates for amniocentesis.

BACKGROUND:Amniocentesis is one of the methods for diagnosing prenatal abnormalities. Pregnant women with high-risk fetal screening results are the candidates for amniocentesis. Most of these women are afraid of this procedure because they predict that the test will be painful and worried about its adverse effects on pregnancy, fetal injury, or the risk of maternal death. Therefore, the aim of this study was to determine the effect of education on the perceived stress of mothers who are the candidates for amniocentesis.MATERIALS AND METHODS:The present study was a quasi-experimental, two-group clinical trial with a parallel design. This study was in three stages: pretest (before intervention), posttest (after intervention), and after amniocentesis. This study was performed on 80 pregnant women who were the candidates for amniocentesis (15–20 weeks of pregnancy) with high-risk fetal screening results referred to the perinatology clinic in Yazd in 2020. The intervention package included training and using breathing techniques, broadcasting educational animations on how to perform amniocentesis, expressing experiences by people who had experienced amniocentesis, and finally visiting the amniocentesis site and getting to know the relevant perinatologist. Data collection tools were demographic and midwifery profile questionnaires and Cohen perceived stress. SPSS software version 16 was used for statistical analysis of data.RESULTS:The results showed that the research units had high stress at the beginning of the study. The perceived stress score at the beginning of the study in the intervention group was 30.1750 ± 6.53153 and in the control group was 28.2750 ± 8.57841. After the intervention, the participants' stress level decreased below the cutting point. In the experimental group, the mean stresses after the intervention and after amniocentesis were significantly lower than before the intervention; however, after amniocentesis, it was somewhat higher than the postintervention stage. In the preintervention stage, the mean stress score between the two groups was not statistically significant. The difference after the intervention between the two groups was significant (P < 001.0); however, in the postamniocentesis stage, the difference in stress was not significant. After the intervention and after amniocentesis, the perceived stress of pregnant mothers in the experimental group was less than the control group.CONCLUSION:Considering that the perceived stress in amniocentesis candidate mothers was high in the present study, so that after performing the method, mothers left the center with high stress, it is very important to pay attention to its psychological aspects. Therefore, it is suggested that educational interventions before and during amniocentesis be considered for them along with psychological support and follow-up care after amniocentesis.