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    Introducing a new series on maternal mortality

    With death rates rising, ob/gyns must dedicate themselves to protecting each mother.

     

    Prevention

    Are maternal deaths preventable? The literature reports that 20% to 50% of maternal deaths may be preventable.10,11 In 2017, data from the CDC MARIA platform reported that 59% of maternal deaths are preventable. This statistic tells us that we have a lot of work to do. Our systems of care must become more proactive and comprehensive for maternal care encompassing antepartum, intrapartum, postpartum and inter-conception care. The first Scientific Statement on Maternal Cardiac Arrest by the American Heart Association* has underscored the tremendous research gaps in maternal resuscitation science.12 Granularity of data capturing details surrounding each maternal death will only be achieved with maternal registries that utilize pregnancy-specific variables that are accessible nationally and maintained with transparency and high fidelity. Better data will facilitate our understanding of maternal pathophysiology and lead to improved maternal care and ultimately better maternal outcomes. Institutional preparedness through simulation training will lead to improvement in medical team performance and communication during the management of obstetrical emergencies. Developing a culture of safety also applies to any location where maternal care takes place. Use of checklists and early warning tools such as the “Obstetric Early Warning Score” has been demonstrated to reduce maternal morbidity and even mortality.13,14

     

    Take-Home Message

    It is hard to imagine that the rise in US maternal mortality rates has had to become a crisis in order to garner our attention. Now that we know about it, we as a society and as health care providers must dedicate ourselves to protecting each mother. While pregnancy is not generally regarded as a disease,15 the unique physiologic adaptations required for the maintenance of pregnancy create a susceptibility to potentially life-threatening illness. We must harness all of our technological ingenuity and medical expertise to conquer maternal mortality. Our mothers are in dire need and are most deserving, worthy of only the best that medical science can offer and deliver.

     

    Disclosures: The author reports no potential conflicts of interest with regard to this article.

    REFERENCES

    1. Kassebaum N et al. Global, regional, and national levels of maternal mortality, 1990-2015: A Systematic analysis for the Global Burden of Disease Study 2015. Lancet.  2016; Oct 8; 388: 1775-1812.

    2. MacDorman MF, Declercq E, Cabral H, Morton C. Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues. Obstet Gynecol. 2016; 128(3):447-455.

    3. World Health Organization. Health statistics and information systems. http://www.who.int/healthinfo/statistics/indmaternalmortality/en/ Accessed November 22, 2017.

    4. Maternal Mortality CDC 2017. Report from Maternal Mortality Review Committees: A View into Their Critical Role. https://www.cdcfoundation.org/sites/default/files/files/MMRIAReport.pdf Accessed November 22, 2017.

    5. Koch AR, Geller SE. Addressing maternal deaths due to violence: the Illinois experience. Am J Obstet Gynecol. 2017; 217(5): 556e1-555e6.

    6. Wallace ME, Hoyert D, Williams C, Mendola P. Pregnancy- associated homicide and suicide in 37 US states with enhanced pregnancy surveillance. Am J Obstet Gynecol.  2016; 215(3): 364 e1-364 e10.

    7. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet and Gynecol. Aug 2017; 130:366-373.

    8. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: Final Data for 2015. National Vital Statistics Reports. 2017; 66 (1): 1-69.

    9. Lisonkova S, Muraca MM, Potts J et al. Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity.JAMA. 2017; 318(18): 1777-1786. 

    10. Berg C J, Harper M A, Atkinson S M, Bell E A, Brown HL., Hage ML., et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet and Gynecol. 2005; 106(6): 1228-1234.

    11. Geller, S. E., Cox, S. M., Kilpatrick, S. J. A descriptive model of preventability in maternal morbidity and mortality. Journal of Perinatology. 2006; 26(2): 79-84.

    12. Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement from the American Heart Association. Circulation.2015; 132(18):1747-1773.

    13. Mhyre JM, D’Oria R, Hameed AB, Lappen JR, Holley SL, Hunter SK et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol 2014;124:782-6.

    14. Patemina-Caicedo A, Miranda J, Bourjelly G, Levinson A, Duenas C, Bello-Munoz C, Rojas-Suarez JA. Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death. Am J Obstet Gynecol. 2017; 216(1): 58.e1-58.e8.

    15. Zelop, CM, Martin SR. Preface: Contemporary Obstetric Intensive Care. In Zelop CM and Martin SR, eds. Obstet Gynecol Clin N AM, Philadelphia, Pennsylvania: Elsevier Inc; 2016; 43: xv-xvi.

    Carolyn Zelop, MD
    Carolyn Zelop is a board-certified Obstetrician/Gynecologist and Maternal-Fetal Medicine specialist at The Valley Hospital in Ridgewood, NJ.

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