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Journal of Women's Health (2002) Feb 2021It is estimated that 1 in 4 women in the United States live with a disability, and using population-based estimates, 10-12% of women of childbearing age have a... (Review)
Review
It is estimated that 1 in 4 women in the United States live with a disability, and using population-based estimates, 10-12% of women of childbearing age have a disability. There are limited data to suggest that women with disabilities experience higher rates of or risks for adverse outcomes related to pregnancy, delivery, and access to appropriate postpartum care. Research on specific disabling conditions demonstrates variable risk for syndromes that threaten the health of the mother, such as preeclampsia, infection, and coagulation disorders. Much of the literature suggests that normal, healthy pregnancy is possible but points to the need for tailored information for patients and providers about the intersection of their condition with pregnancy and specific care needs. Given the lack of systematic evidence in this area across conditions and functional impairments, more research is needed to clarify the interaction of specific disabilities with pregnancy and provide evidence-based information to the field to decrease the risks to mothers and their infants. This article will provide an overview of conditions that contribute to maternal morbidity and mortality as they relate to pregnancy in women with disabilities and provide resources to the field to further the investigation of this area.
Topics: Disabled Persons; Female; Humans; Infant; Maternal Mortality; Mothers; Pre-Eclampsia; Pregnancy; United States
PubMed: 33216671
DOI: 10.1089/jwh.2020.8864 -
Taiwanese Journal of Obstetrics &... Jul 2021
Topics: Aged; Female; Humans; Maternal Age; Maternal Mortality; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Risk Factors
PubMed: 34247791
DOI: 10.1016/j.tjog.2021.05.001 -
International Journal of Environmental... Jun 2023We used a mixed design study to analyze the inequalities and inequities in Maternal Mortality (MM) for Chocó (Colombia) between 2010-2018. The quantitative component...
We used a mixed design study to analyze the inequalities and inequities in Maternal Mortality (MM) for Chocó (Colombia) between 2010-2018. The quantitative component consisted of an analytical ecological design, where proportions, ratios, measures of central tendency and rates ratios, rate difference, Gini and concentration indices were calculated to measure inequalities. The qualitative component had a phenomenological and interpretive approach. One hundred thirty-one women died in Choco between 2010-2018. The Maternal Mortality Ratio was 224/100.000 live births. The Gini coefficient was 0.35, indicating inequality in the distribution of the number of MM with respect to live births. The health service offers have been concentrated in the private sector in urban areas (77%). The exercise of midwifery has played an important role in maternal and perinatal care processes, especially in territories where the State has been absent. Nevertheless, it occurs in complex circumstances such as the armed conflict, lack of transportation routes, and income deficits, affecting the timelines and care quality for these vulnerable groups. MM in Chocó has been a consequence of deficiencies in the health system and weaknesses in its infrastructure (absence of a high level of maternal-perinatal care). This is in addition to the territory's geographical characteristics, which increase vulnerability and health risks for women and their newborns. In Colombia, as well as in other countries, many maternal and newborn deaths are preventable because their causes are due to social injustices.
Topics: Pregnancy; Humans; Infant, Newborn; Female; Maternal Mortality; Colombia; Maternal Health Services; Income; Midwifery; Socioeconomic Factors
PubMed: 37372682
DOI: 10.3390/ijerph20126095 -
Journal of Global Health Jul 2023Despite improvements in many health indicators, maternal mortality has plateaued in Bangladesh. Achieving the global target of reductions in maternal mortality and the...
BACKGROUND
Despite improvements in many health indicators, maternal mortality has plateaued in Bangladesh. Achieving the global target of reductions in maternal mortality and the associated Sustainable Development Goals will not be possible without actions to prevent deaths due to preeclampsia/eclampsia. Here we examined the levels, trends, specific causes, timing, place, and care-seeking behaviours of women who died due to these two causes.
METHODS
We used nationally representative Bangladesh Maternal Mortality and Health Care Surveys (BMMSs) conducted in 2001, 2010, and 2016 to examine levels and trends of deaths due to preeclampsia/eclampsia. We based the analysis of specific causes, timing, and place of preeclampsia/eclampsia deaths, and care seeking before the deaths on 41 such deaths captured in the 2016 survey. We also used BMMS 2016 survey verbal autopsy (VA) questionnaire to highlight stories that put faces to the numbers.
RESULTS
The preeclampsia/eclampsia-specific mortality ratio decreased from 77 per 100 000 live births in the 2001 BMMS to 40 per 100 000 live births in the 2010 BMMS, yet halted in the 2016 BMMS at 46 per 100 000 live births. Although preeclampsia/eclampsia accounted for around one-fifth of all maternal deaths in the 2010 BMMS, in the 2016 BMMS, the percentage contribution reached the 2001 BMMS level of 24%. An analysis of the VA questionnaire's open section showed that almost all such death cases left their homes to seek care; however, most had to visit more than one facility before they died, indicating an unprepared health system.
CONCLUSIONS
A cluster of preeclampsia/eclampsia-specific mortality observed during the first trimester, during delivery, and within 48 hours of birth indicates a need for preconception health check-ups and strengthened facility readiness. Awareness of maternal complications, proper care seeking, and healthy reproductive practices, like family planning to space and limit pregnancy through client-supportive counselling, may be beneficial. Improving regular and emergency maternal services readiness is also essential.
Topics: Pregnancy; Female; Humans; Eclampsia; Pre-Eclampsia; Maternal Mortality; Bangladesh
PubMed: 37441775
DOI: 10.7189/jogh.13.07003 -
Journal of Women's Health (2002) Aug 2021Multisectoral investments over the past decade have accelerated the growth of Maternal Mortality Review Committee (MMRC) programs across the United States. The U.S....
Multisectoral investments over the past decade have accelerated the growth of Maternal Mortality Review Committee (MMRC) programs across the United States. The U.S. Centers for Disease Control and Prevention (CDC) launched the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Initiative in 2019. Under ERASE MM, CDC directly funds 24 U.S. jurisdictions supporting MMRCs in 25 states. With increased investment in programs nationally, the CDC has designed a performance management framework to identify areas for improvement or sustained achievement and standardize measurement of key process benchmarks across programs. This article presents a report on the baseline measures collected through this performance management approach and suggests key partnerships required to continue to accelerate progress toward the elimination of preventable maternal mortality in the United States.
Topics: Advisory Committees; Centers for Disease Control and Prevention, U.S.; Humans; Maternal Mortality; Population Surveillance; United States; Female
PubMed: 34410869
DOI: 10.1089/jwh.2021.0357 -
Nursing Research 2020Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no...
BACKGROUND
Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no published reports of maternal mortality data stratified by timing of its occurrence across the pregnancy continuum (antepartum, intrapartum, and postpartum).
OBJECTIVE
The study objective was to determine whether the maternal mortality rate, trends over time, self-reported race/ethnicity, and associated factors vary based on the timing of the occurrence of death during pregnancy.
METHODS
We conducted a cross-sectional analysis of the Nationwide Inpatient Sample database to identify pregnancy-related inpatient stays stratified by timing. Among women in the sample, we determined in-hospital mortality and used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify comorbidities and behavioral characteristics associated with mortality, including alcohol, drug, and tobacco use. Joinpoint regression was used to calculate rates and trends of in-hospital maternal mortality.
RESULTS
During the study period, there were 7,411 inpatient maternal mortalities among an estimated 58,742,179 hospitalizations of women 15-49 years of age. In-hospital maternal mortality rate stratified by race showed that African Americans died at significantly higher rates during antepartum, intrapartum, and postpartum periods compared to hospitalizations for Whites or Hispanics during the same time period. Although the postpartum hospitalization represents only 2% of pregnancy-related hospitalizations among women aged 15-49 years, hospitalization during this time period accounted for 27.2% of all maternal deaths during pregnancy-related hospitalization.
DISCUSSION
Most in-hospital maternal mortalities occur after hospital discharge from child birth (postpartum period). Yet, the postpartum period continues to be the time period with the least maternal healthcare surveillance in the pregnancy continuum. African American women experience three times more in-hospital mortality when compared to their White counterparts.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Forecasting; Hospital Mortality; Humans; Maternal Mortality; Middle Aged; Pregnancy; Pregnancy Complications; Time Factors; United States; Young Adult
PubMed: 31609900
DOI: 10.1097/NNR.0000000000000397 -
JPMA. the Journal of the Pakistan... Jul 2021To determine the frequency and causes of maternal near-miss and mortality among pregnant women.
OBJECTIVE
To determine the frequency and causes of maternal near-miss and mortality among pregnant women.
METHODS
The cross-sectional prospective study was conducted from January 2016 to December 2018 at the Services Hospital, Lahore, Pakistan, and comprised all near-miss cases admitted in the gynaecology department. The World Health Organisation criterion was used to identify the near-miss cases. Primary outcome measures were frequency and causes of near-miss and the ratio between maternal mortality and near-miss cases. Secondary outcome measures were delays, need for massive blood transfusion, intensive care unit admission, obstetric hysterectomy and hospital stay >7 days. Data was analysed using SPSS 23.
RESULTS
Of the 10,739 live births, there were 344(3.2%) complications resulting in 305(2.8%) near-miss cases and 29(0.3%) maternal deaths. Frequency of near miss was 28.4 per 1000 live births and the ratio between maternal mortality and near-miss cases was 1:10.5. There were 215(62.5%) unbooked patients and 23(6.7%) of them died (p<0.001). Among the near-miss cases, haemorrhage accounted for 150(49.18%), hypertensive disorders 102(33.44%), cardiac disease 25(8.28%) and infection 12(3.97%). Maternal mortality was significantly low for haemorrhage, hypertension, sepsis and cardiac disease (p<0.001). Massive blood transfusion was given to 64(20.98%) patients, 48(15.74%) underwent hysterectomy, and 98(32.13%) required admission to intensive care unit. First and second delays were seen in 240(78.6%) near-miss and 25(86.2%) mortality cases (p<0.001).
CONCLUSIONS
Haemorrhage and hypertension were found to be major reasons for near-miss cases, but timely intervention could prevent mortality.
Topics: Cross-Sectional Studies; Female; Humans; Maternal Mortality; Near Miss, Healthcare; Pregnancy; Pregnancy Complications; Prospective Studies; Tertiary Care Centers
PubMed: 34410259
DOI: 10.47391/JPMA.05-678 -
Epidemiologia E Servicos de Saude :... 2023To analyze the spatio-temporal pattern of maternal mortality and associated factors in Northeast Brazil, from 2009 to 2019.
OBJECTIVE
To analyze the spatio-temporal pattern of maternal mortality and associated factors in Northeast Brazil, from 2009 to 2019.
METHODS
This was an ecological study using the joinpoint method for temporal analysis and spatial autocorrelation and scan tests to identify clusters; regression models using the ordinary least squares and geographically weighted regression methods were used to identify factors associated with mortality, considering p-value < 0.05.
RESULTS
Maternal mortality decreased by 1.5% (95%CI; -2.5;-0.5) per year (p-value = 0.009); clusters, of deaths were found, mainly in Piauí and Maranhão, the variables associated with the maternal mortality ratio were Gini Index (β = 105.72; p-value < 0.001), municipal human development index (β = 190.91; p-value = 0.001), per capita income (β = -0.08; p-value = 0.001), Firjan Municipal Development Index-Health (β = -51.28; p-value < 0.001), life expectancy at birth (β = -3.50; p-value < 0.001).
CONCLUSION
There was a reduction in mortality in the period studied, with a concentration of deaths, primarily in Piauí and Maranhão; socioeconomic indicators were associated with higher mortality in the region.
MAIN RESULTS
There was a decrease in maternal mortality in Northeast Brazil, from 2009 to 2019. Deaths were mainly concentrated in the states of Piauí and Maranhão. Five socioeconomic indicators were associated with higher mortality in the region.
IMPLICATIONS FOR SERVICES
In order to maintain the trend of falling maternal mortality in Northeast Brazil, the need exists to reduce social inequalities and expand access to health services, especially within the scope of Primary Care.
PERSPECTIVES
Public policies are needed to expand health services in general as well as comprehensive women's health care in the Brazilian National Health System, especially for women living in contexts of greater social vulnerability.
Topics: Infant, Newborn; Humans; Female; Brazil; Maternal Mortality; Socioeconomic Factors; Income; Spatial Analysis
PubMed: 37909520
DOI: 10.1590/S2237-96222023000300009.EN -
BMC Pregnancy and Childbirth Nov 2023To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated with incompleteness and/or misclassification of maternal death data.
METHODS
We conducted a systematic review of incompleteness and/or misclassification of maternal and pregnancy-related deaths. We conducted a narrative synthesis to identify methods used to capture and classify maternal deaths, as well as general and context specific factors affecting the completeness and misclassification of maternal death recording. We conducted a meta-analysis of proportions to obtain estimates of incompleteness and misclassification of maternal death recording, overall and disaggregated by income and surveillance system types.
FINDINGS
Of 2872 title-abstracts identified, 29 were eligible for inclusions in the qualitative synthesis, and 20 in the meta-analysis. Included studies relied principally on record linkage and review for identifying deaths, and on review of medical records and verbal autopsies to correctly classify cause of death. Deaths to women towards the extremes of the reproductive age range, those not classified by a medical examiner or a coroner, and those from minority ethnic groups in their setting were more likely misclassified or unrecorded. In the meta-analysis, we found maternal death recording to be incomplete by 34% (95% CI: 28-48), with 60% sensitivity (95% CI: 31-81.). Overall, we found maternal mortality was under-estimated by 39% (95% CI: 30-48) due to incompleteness and/or misclassification. Reporting of deaths away from the intrapartum, due to indirect causes or occurring at home were less complete than their counterparts. There was substantial between and within group variability across most results.
CONCLUSION
Maternal deaths were under-estimated in almost all contexts, but the extent varied across settings. Countries should aim towards establishing Civil Registration and Vital Statistics systems where they are not instituted. Efforts to improve the completeness and accuracy of maternal cause of death recording, such as Confidential Enquiries into Maternal Deaths, are needed even where CRVS is considered to be well-functioning.
Topics: Pregnancy; Humans; Female; Maternal Death; Maternal Mortality; Reproduction; Family; Ethnicity; Cause of Death
PubMed: 37968585
DOI: 10.1186/s12884-023-06077-4 -
Eastern Mediterranean Health Journal =... Sep 2022Investing in the health of women and girls has been shown to produce good returns not only for women and girls, but also for the society as a whole. It yields high...
Investing in the health of women and girls has been shown to produce good returns not only for women and girls, but also for the society as a whole. It yields high returns on investment through improved productivity, reduced absenteeism, and reduced health care costs. Over the past decades the terms women's health and reproductive health were used interchangeably to refer to conditions related to pre-conception, pregnancy, childbirth, and postnatal care only. However, with the improvement in life expectancy, reduction in maternal mortality ratios and the constant reduction in fertility rates, women now enjoy more years and are exposed to risk factors and diseases that are not always related to the reproductive function. Women in the post-menopausal period undergo physiological and psychological changes that may cause discomfort or change their response to several risk factors, and some diseases may present differently in women than in men. With this in mind, and in an attempt to better understand and respond to women's comprehensive health needs, the WHO Office for the Eastern Mediterranean Region (WHO/EMRO) launched a programme on women's health to generate and analyze evidence related to women's overall health beyond the reproductive component and propose relevant solutions. We need to act now to ensure that health services for women are available, acceptable, and accessible, to ensure that women's health needs are well-covered in the hope of achieving Universal Health Coverage by 2030.
Topics: Birth Rate; Female; Health Services; Humans; Life Expectancy; Male; Maternal Mortality; Pregnancy; Women's Health
PubMed: 36205201
DOI: 10.26719/2022.28.9.635