The Journal of the Arkansas Medical Society Issue 9 Vol 114 | Page 12

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EDITORIAL PANEL
Chad T. Rodgers, MD, FAAP; Elena M. Davis, MD, MPH;
Michael Moody, MD; J. Gary Wheeler, MD, MPS
Strategies to Improve Maternal
Mortality and Morbidity
BY MICHELLE MURTHA, RN
W
omen in the United States
are more likely to die from
childbirth or pregnancy-
related causes than other women in
high-income countries, according to
the Centers for Disease Control and
Prevention (CDC). More than 700 wom-
en die each year in the United States
due to pregnancy and childbirth-
related complications, ranking us 46th
for maternal mortality, behind all other
developed nations. The CDC’s National
Vital Statistics System ranks Arkansas
with the third-highest maternal mortal-
ity rate in the nation. Arkansas has 35
maternal deaths per 100,000 live births,
compared to the national average of 20
deaths per 100,000 live births.
Maternal mortality is increasing,
but serious morbidity is increasing
even faster. The CDC reports more
than 60,000 new mothers annually
experience serious or life-threatening
complications. From 1993 to 2014, the
serious-complication rate more than
doubled. New mothers needing resus-
citation from heart failure increased
by 175 percent; the need for endotra-
cheal tubes and treatment of sepsis
both increased by 75 percent. Cesar-
ean births (C-sections) have increased
from less than 5 percent in the 1960s
to 33 percent in 2016 — about twice
the rate in European countries. C-sec-
tions increase the risk for hemorrhag-
es, blood clots, infections and uterine
ruptures in subsequent pregnancies.
The rate of women who have their
labor induced has more than doubled
in the last 20 years. Induction leads to
more prolonged labor, increasing the
risk of hemorrhage.
The reasons for this increase appear
to be a combination of factors includ-
ing access to care; pre-existing chronic
conditions like pre-pregnancy obesity,
hypertension, diabetes and cardiovas-
cular disease; increases in maternal
age and drug addiction; and the use of
tobacco products and alcohol.
The risk of pregnancy-related
deaths for black women is three
to four times higher than for white
or Hispanic women. Even healthy
women who give birth are at risk for
these complications.
The leading causes of maternal
death are hemorrhage, hyperten-
sive disorder, pulmonary embolism,
amniotic fluid embolism, infection
and pre-existing chronic conditions
mentioned above.
The most common preventable
errors that lead to maternal mortal-
ity and morbidity include: failure to
adequately control blood pressure
in hypertensive women, failure to
diagnose and treat pulmonary edema
in women with preeclampsia, and
insufficient attention to vital signs or
hemorrhage following Cesarean birth.
The cost of caring for severe mater-
nal morbidity costs billions of dollars
a year. Treating just one complica-
tion — preeclampsia — exceeds $1
billion annually, according to a 2017
report from the American Journal of
Obstetrics and Gynecology.
ARKANSAS’ STRATEGY
The postpartum period is a critical
time to ensure women and their new-
borns are healthy. It is important for
women, family members and health
care professionals to be educated
about the warning signs that can
potentially lead to maternal death.
Efforts to reduce maternal
mortality and morbidity in
Arkansas started in the hospital
with maternal safety bundles,
developed and endorsed by national
multidisciplinary organizations.
Maternal safety bundles include
action measures for:
• Obstetrical hemorrhage
• Severe hypertension/preeclampsia
• Prevention of venous
thromboembolism
• Reduction of low-risk primary
Cesarean births/support for
intended vaginal births
• Reduction of peripartum
racial disparities
• Postpartum care access
and standards
THE ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) WORKS COLLABORATIVELY WITH PROVIDERS, COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO PROMOTE THE QUALITY
OF CARE IN ARKANSAS THROUGH EDUCATION AND EVALUATION. FOR MORE INFORMATION ABOUT AFMC QUALITY IMPROVEMENT PROJECTS, CALL 1-877-375-5700. • MARCH 2018
204 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 114