Clinical Review
2014 Update on operative vaginal delivery
New data confirm that the combination of forceps and vacuum extraction should be avoided and demonstrate that use of midcavity rotational forceps...
In order to reduce the risk of unintended pregnancy in women with high-risk medical problems, health systems could make contraception an important “vital sign” for women with high-risk medical conditions.
Race and age matter greatly when it comes to maternal mortality risk
There are major racial differences in pregnancy-related mortality, with black women having much higher rates than white women. In the United States in 2011, the pregnancy-related mortality ratio for white, black, and women of other races was 12.5, 42.8, and 17.3 deaths per 100,000 live births, respectively. This represents a major racial disparity in pregnancy outcomes.1
The age of the mother is an important determinant of the risk of maternal death. Women younger than age 35 years have the lowest risk of maternal death. From 2006 to 2010, pregnant women older than age 40 had a risk of death approximately 3 times greater than women aged 34 or younger.2
References
- Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention Web site. http://www .cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html. Accessed August 20, 2015.
- Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol. 2015;125(1):5−12.
Let’s get organized
In a country with a history of embracing the “live free or die” ethic, it is often difficult for physicians to enthusiastically embrace the need for a higher level of organization and a potential reduction in individual freedom in order to improve health outcomes. And with a US maternal mortality ratio of 1 maternal death for every 5,400 births, many obstetricians will never have one of their patients die in childbirth. In fact, most obstetricians will have only 1 maternal death during their entire career. In this reality, when clinical events occur rarely, it is not possible for any single clinician, working alone, to impact the overall outcomes of those rare events. Therefore, teamwork and national efforts, such as the National Partnership for Maternal Safety,13 will be necessary to reverse our alarming trend of increasing maternal mortality. Let’s get organized to stop the rise of maternal deaths in the United States.
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