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Maternal Mortality 2018: A Call to Action

This article discusses the historical and cultural perspective of maternal mortality, the reasons for the increase in maternal deaths, the link between obesity and maternal death, and the importance of systems-based approaches and individual measures for prevention. It also provides insights into the history of maternal mortality review in the USA.

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Maternal Mortality 2018: A Call to Action

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  1. Maternal Mortality 2018:A Call to Action Donald J. Dudley, M.D. Department of Obstetrics and Gynecology University of Virginia

  2. Disclosures • I have no relevant disclosures.

  3. A Historical and Cultural Perspective

  4. Genesis 35:17-20 • When her pangs were most severe, her midwife said to her, “Have no fear! This time, too, you have a son”. With her last breath—for she was at the point of death—she called him Ben-oni; his father, however, named him Benjamin. Thus Rachel died; and she was buried on the road to Ephrath [that is, Bethlehem]. Jacob set up a a memorial stone on her grave, and the same monument marks Rachel’s grave to this day.

  5. Shah Jahan MumtazMahal

  6. Martha Wayles Skelton Jefferson Died September 6, 1782 Mary “Polly” Jefferson Eppes Died April 17, 1804 Anne Randolph Bankhead Died February 11, 1826

  7. Padme Amidala

  8. Tom Riddle, son of Merope Gaunt

  9. But Why the Increase?The Causes of Maternal Death

  10. Reasons for the Increase • Ascertainment Complexities • Delayed Childbearing • Obesity Epidemic • Increase in Cesarean Deliveries • Severity of Maternal Medical Conditions SemPerinatol 2012;36:14-18

  11. In Maryland from 1993-2000 (n=129), 38% of Maternal Deaths are Not Reported on Death Certificates

  12. Reasons for the Increase • Ascertainment Complexities • Delayed Childbearing • Obesity Epidemic • Increase in Cesarean Deliveries • Severity of Maternal Medical Conditions SemPerinatol 2012;36:14-18

  13. Reasons for the Increase • Ascertainment Complexities • Delayed Childbearing • Obesity Epidemic • Increase in Cesarean Deliveries • Severity of Maternal Medical Conditions SemPerinatol 2012;36:14-18

  14. Obesity and Maternal Death • Louis, et al. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep 2014;37:843-849. • Nationwide Inpatient Sample database • 55 million hospital discharges • OSA related to Increased Odds: • Preeclampsia: 2.5 (2.2-2.9) • Eclampsia: 5.4 (3.3-8.9) • Cardiomyopathy: 9.0 (7.5-10.9) • Pulmonary Embolism: 4.5 (2.3-8.9) • In-hospital Mortality: 5 (2.4-11.5)

  15. Reasons for the Increase • Ascertainment Complexities • Delayed Childbearing • Obesity Epidemic • Increase in Cesarean Deliveries • Unmasking of Maternal Medical Conditions SemPerinatol 2012;36:14-18

  16. Clark, et al. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J ObstetGynecol 2008;199:e1-36.

  17. Reasons for the Increase • Ascertainment Complexities • Delayed Childbearing • Obesity Epidemic • Increase in Cesarean Deliveries • Severity of Maternal Medical Conditions SemPerinatol 2012;36:14-18

  18. Hospitalization for Severe Maternal Morbidity: USA 1988-2011 Creanga, et al. Maternal Mortality in the United States: Where are We Now? J Women’s Health 2014;23:3-9.

  19. Prevention of Maternal Death Systems-Based Approaches Individual Measures

  20. Maternal Mortality Review Berg C. From identification to review to action—maternal mortality review in the United States. SemPerinatol 2012;36:7-13

  21. History of Maternal Mortality Review in the USA Marmol, et al. History of the Maternal Mortality Study Committees In the United States. ObstetGynecol 1969;34:123-138

  22. Maternal Mortality Review Main E. Decisions required for operating a maternal mortality review committee: the California experience. SemPerinatol 2012:36:37-41

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