Quality & Patient Safety

How to prevent maternal mortality

Patient Safety Monitor, October 1, 2017

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

Maternal mortality is a measure of how many mothers die from pregnancy-related complications while carrying or within 42 days after birth. And in most of the developed world, this number has fallen to historic lows.

But not in the U.S., where the maternal mortality rate (MMR) has grown 2.7% between 2000 and 2015. Annually, there are 700–900 maternity deaths, 60% of which are preventable. An additional 65,000 people nearly die due to pregnancy complications.

For perspective, the U.S. MMR is 26.4 deaths per 100,000 live births. In Kazakhstan, the MMR is 26.5 per 100,000. But unlike America, Kazakhstan’s MMR has fallen 5.6% over the past 15 years.

America’s maternity deaths are even worse when compared to other developed nations. The United Kingdom has an MMR of 9.2, down 2.5% since 2000. In fact, a British man is “more likely to die while his partner is pregnant than she is.” And the UK’s MMR is higher than that of Sweden (4.4), Norway (3.8), Ireland (4.7), Italy (4.2), and many others. 

While this is bleak news for providers and patients, there are signs of hope out west. In the past decade, California has been the only state to buck the national trend and reduce MMR, down to seven deaths per 100,000. California hospitals have adopted a number of guidelines and best practices around maternal care, blood loss, C-sections, pre-conception planning, and other topics.

While these tools and guidelines haven’t been implemented nationwide yet, they have great promise in reversing this disturbing health trend in American hospitals and clinics.

Maternal mortality complications
Michelle Genova, RNC, MSN, executive director of women’s services at St. Joseph’s Hospital in Orange, California, says the rise in maternal mortality is linked to the rise in chronic health conditions in women, such as high blood pressure, obesity, diabetes, hyper-tension, blood clots, etc. St. Joseph’s is the second largest obstetrics hospital in southern California and conducts 5,000 deliveries and 3,500 outpatient preg-nancy-related visits each year.

These chronic conditions can be extremely detrimental to pregnancies if not properly managed, Genova says. There are also new concerns over the impact congenital anomalies have on maternal mortality.

“Specifically cardiac anomalies and some others [in people] that are surviving into womanhood and having children of their own,” she says. “Those kinds of situations are new to this generation of people and something we have to take into consideration.”

Randy Fiorentino, MD, an obstetrics/gynecology physician at St. Joseph’s, says age is a large determinant in maternal mortality rates, and many women in the U.S. are getting pregnant at older ages.

“When they’re starting their families and childbearing in their 20s and their early 30s, they have much less chronic health conditions,” Fiorentino says. “When women start their families over the age of 35 and 40, there’s a lot of other chronic health conditions that affect pregnancy.”

Paula Turicchi, FACHE, senior vice president of women & infants specialty health at Parkland Health & Hospital System (PHHS) in Dallas, says a major challenge to maternity care is that not all hospitals are equipped to handle complex pregnancies. This can become a problem when patients live in an underserved or remote location, far from the care they need.

 “We may see women in our maternal/fetal medicine clinic where we have specialists who’ll treat women who may have had an aneurysm or a cardiac condition before they got pregnant,” Turicchi says. “But they seek pregnancy and they have the ability to see a maternal/fetal specialist here at [PHHS]. That might not be the case in outlying areas or rural areas or non-urban settings.”

One method Texas and other states are using to combat this is a ranking system for hospitals, with Level 1 only having the most basic maternity care and Level 4 having the most complex. That way patients can tell which facilities are best equipped to handle their care.

The U.S. maternal mortality rate is 26.4 deaths per 100,000 live births. In Kazakhstan, the rate is 26.5 per 100,000. 

Prenatal care is key
The biggest challenge fighting maternal mortality, Fiorentino says, is that patients don’t come in for pre-conceptional visits. That puts physicians behind the ball right from the start.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

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