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Clinical Medicine (London, England) Jun 2017The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern... (Review)
Review
The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.
Topics: Female; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications
PubMed: 28572227
DOI: 10.7861/clinmedicine.17-3-251 -
Swiss Medical Weekly Oct 2020Maternal mortality is an important indicator for quality control in obstetrics. To improve clinical care, maternal mortality should be assessed periodically. In this...
INTRODUCTION
Maternal mortality is an important indicator for quality control in obstetrics. To improve clinical care, maternal mortality should be assessed periodically. In this study, we analysed maternal mortality cases between 2005 and 2014 in Switzerland and compared them with those in earlier periods.
METHODS
The Federal Statistical Office (FSO) provided all death certificates between 2005 and 2014 with an ICD-10 code in the obstetric field (indicated with the letter O). Additionally, we included all death certificates that gave a positive answer about pregnancy or birth within the last 42 days. We also included cases where death occurred within 365 days after delivery. For an analysis of underreporting, cases from the Institute of Forensic Medicine (IRM), Zurich, were included. The cases were classified according to ICD-10 as “direct”, “indirect”, “non-pregnancy-related”, and “late” deaths. The direct maternal mortality rate (MMR), and indirect and combined MMRs were calculated.
RESULTS
We received 117 cases from the FSO, and one additional case was found in the archives of the IRM. Ninety-six cases were eligible for detailed evaluation. As 787,025 live births were recorded between 2005 and 2014 in Switzerland, the direct MMR was 3.30/100,000 live births (26 cases). It has decreased by 20.5% compared with the MMR in 1995–2004 (4.15/100,000 live births, 32 cases; p = n.s.) and by 40.4% compared with the MMR in 1985–1994 (5.54/100,000 live births, 45 cases; odds ratio [OR] 0.6, p = 0.04, 95% confidence interval [CI] 0.37–0.97). The leading cause for direct maternal mortality in the current study period was haemorrhage (nine cases), followed by amniotic fluid embolisms and preeclampsia (five cases each). The indirect MMR was 3.68/100,000 live births. In this group, 13 women committed suicide and 8 women died of complications of pre-existing cardiac pathologies. Suicide was the leading cause of maternal deaths, had suicides been classified as direct obstetric cases. The combined MMR (direct and indirect) was 6.61/100,000 live births (52 cases) (OR 4.8–8.4). Of 41 non-pregnancy-related cases, almost half (20 cases) died of cancer within the first year after delivery. Lethality after caesarean section was 0.008‰ (2/231,385).
CONCLUSIONS
The trend of reducing direct maternal mortality as well as lethality after caesarean section continues. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. Indirect maternal mortality is increasing and specifically suicides need special attention. Precise documentation of all maternal deaths is essential to improve outcomes for future mothers.
Topics: Cause of Death; Cesarean Section; Female; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications; Suicide; Switzerland
PubMed: 33085769
DOI: 10.4414/smw.2020.20345 -
Journal of Women's Health (2002) Feb 2021The pregnancy-related mortality rate in the US exceeds that of other developed nations and is marked by significant disparities in outcome by race. This article reviews... (Review)
Review
The pregnancy-related mortality rate in the US exceeds that of other developed nations and is marked by significant disparities in outcome by race. This article reviews the evidence supporting the implementation of a variety of best practices designed to reduce maternal mortality. Evidence from maternal mortality review committees suggests that delays in diagnosis, delays in initiation of treatment and use of ineffective treatments contribute to preventable cases of maternal death. We review several protocols for maternal warning signs that have been used successfully to facilitate early identification and intervention. Care bundles, a collection of best practices, have been developed and implemented to address several maternal emergencies. We review the evidence that supports reduction in adverse outcomes with consistent implementation of obstetric hemorrhage and severe hypertension bundles in a collaborative, team-based setting. The article concludes with suggestions for the future.
Topics: Female; Hemorrhage; Humans; Maternal Death; Maternal Mortality; Pregnancy; Risk Assessment
PubMed: 33227226
DOI: 10.1089/jwh.2020.8878 -
Revista de Saude Publica 2020To estimate maternal mortality ratio according to occupation in Brazil.
OBJECTIVE
To estimate maternal mortality ratio according to occupation in Brazil.
METHODS
This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002.
RESULTS
A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found."Housewife" prevailed in SIM (35.5%) and SINASC (39.1%).
CONCLUSIONS
Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.
Topics: Birth Certificates; Brazil; Death Certificates; Female; Humans; Maternal Mortality; Occupations; Pregnancy
PubMed: 32609276
DOI: 10.11606/s1518-8787.2020054001736 -
Indian Journal of Public Health 2017
Topics: Female; Health Status Disparities; Healthcare Disparities; Humans; India; Maternal Mortality; Pregnancy
PubMed: 29219125
DOI: 10.4103/ijph.IJPH_323_17 -
Seminars in Perinatology Aug 2017The disparity in maternal mortality for African American women remains one of the greatest public health inequities in the United States (US). To better understand... (Review)
Review
The disparity in maternal mortality for African American women remains one of the greatest public health inequities in the United States (US). To better understand approaches toward amelioration of these differences, we examine settings with similar disparities in maternal mortality and "near misses" based on race/ethnicity. This global analysis of disparities in maternal mortality/morbidity will focus on middle- and high-income countries (based on World Bank definitions) with multiethnic populations. Many countries with similar histories of slavery and forced migration demonstrate disparities in health outcomes based on social determinants such as race/ethnicity. We highlight comparisons in the Americas between the US and Brazil-two countries with the largest populations of African descent brought to the Americas primarily through the transatlantic slave trade. We also address the need to capture race/ethnicity/country of origin in a meaningful way in order to facilitate transnational comparisons and potential translatable solutions. Race, class, and gender-based inequities are pervasive, global themes. This approach is human rights-based and consistent with the UN Millennium Development Goals (MDG) and post 2015-sustainable development goals' aim to place women's health the context of health equity/women's rights. Solutions to these issues of inequity in maternal mortality are nation-specific and global.
Topics: Female; Global Health; Health Status Disparities; Humans; Internationality; Maternal Mortality; Quality Improvement; Women's Health
PubMed: 28669415
DOI: 10.1053/j.semperi.2017.04.009 -
Clinical Obstetrics and Gynecology Jun 2018
Topics: Female; Humans; Maternal Health; Maternal Mortality; Pregnancy; Pregnancy Complications; Quality Improvement
PubMed: 29688936
DOI: 10.1097/GRF.0000000000000376 -
Reproductive Sciences (Thousand Oaks,... Apr 2019Maternal mortality remains one of the leading causes of death in women of reproductive age in developing countries, and a major concern in some developed countries. It... (Review)
Review
Maternal mortality remains one of the leading causes of death in women of reproductive age in developing countries, and a major concern in some developed countries. It is puzzling why such a condition has not been reduced in frequency, if not eliminated, in the course of evolution. Maternal mortality is a complex phenomenon caused by several physiological and physical factors. Among the physical factors, maternal mortality due to fetopelvic disproportion remains controversial. Several explanations including evolution of bipedal locomotion, rapid brain growth, and nutritional changes and life style changes in settler communities have been proposed. The influences of human reproductive biology and sexual selection have rarely been considered to explain why maternal mortality persisted through human evolution. We entertain the hypothesis that irrespective of the causes, the risks of all factors causing maternal mortality would be aggravated by disassortative mating, specifically male preference for younger females who are generally small statured and at higher risk of obstetric complications. Maternal mortality arising due to sexual selection and mate choice would have the long-term effect of driving widowers toward younger women, often resulting in "child marriage," which still remains a significant cause of maternal mortality globally. Evolutionarily, such a male driven mating system in polygamous human populations would have prolonged the persistence of maternal mortality despite selection acting against it. The effects may extend beyond maternal mortality because male-mate choice driven maternal mortality would reduce average reproductive life spans of women, thus influencing the evolution of menopause.
Topics: Biological Evolution; Female; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications; Reproduction; Risk Factors; Sexual Behavior
PubMed: 30545276
DOI: 10.1177/1933719118812730 -
American Journal of Public Health Apr 2020
Topics: Female; Humans; Maternal Death; Maternal Mortality; Pregnancy; Pregnancy Complications; Public Health; Race Factors; Socioeconomic Factors; United States
PubMed: 32159977
DOI: 10.2105/AJPH.2019.305552 -
Revista Brasileira de Ginecologia E... Sep 2018
Topics: Brazil; Female; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications
PubMed: 30231288
DOI: 10.1055/s-0038-1672181