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Pettersen S, Falk RS, Vangen S, Nyfløt LT. Tone or tissue? A comparison of trends and risk factors of severe postpartum hemorrhage according to uterine atony or retained tissue in a hospital setting. PLoS One 2025; 20:e0318770. [PMID: 39899591 PMCID: PMC11790139 DOI: 10.1371/journal.pone.0318770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 01/22/2025] [Indexed: 02/05/2025] Open
Abstract
OBJECTIVE To compare trends, outcomes and risk factors for severe postpartum hemorrhage (PPH) due to uterine atony and retained tissue separately. STUDY DESIGN This retrospective hospital-based study of severe PPH included deliveries from a 10-year cohort (2008-2017) and a four-year case-control group (2008-2011). Severe PPH was defined as an estimated blood loss of ≥1500 ml or a blood transfusion. Poisson regression was used to estimate the temporal trend in the 10-year cohort. Risk factors were investigated in the case-control group. We performed multinomial regression analysis to investigate associations between pregnancy characteristics and severe PPH caused by uterine atony and by retained tissue compared to controls without severe PPH. RESULTS During the 10-year study period, 2.7% of all deliveries were complicated by severe PPH. Uterine atony without concurring retained tissue was the cause in 55.4%, while retained tissue was listed as a cause in 32.2% of the cases. Among women who received ≥ four units of blood products, retained tissue caused 42.6% of cases, and severe PPH resulting in a hysterectomy was caused by retained tissue in 61.2% of cases. The rate of severe PPH caused by uterine atony significantly increased during the study period with an estimated annual percentage change of 8.6%, while the increase in severe PPH due to retained tissue was non-significant. Risk factors associated only with uterine atony were multiple pregnancy, macrosomia, Asian ethnicity and operative delivery, while induction of labor, augmentation of labor, use of anticoagulants and assisted reproduction were associated with both uterine atony and retained tissue. CONCLUSION The observed increased rate of PPH in the study period was mainly driven by an increase in atonic PPH, while the rate of severe PPH caused by retained tissue remained stable. The proportion caused by retained tissue was highest among the most severe cases of PPH. The reason for the increase in severe PPH due to uterine atony, but not retained tissue was not clear, but we speculate that it may be a combination of increasing risk factors with increased awareness of PPH.
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Affiliation(s)
- Silje Pettersen
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lill Trine Nyfløt
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
- Department of Obstetrics, Drammen Hospital, Drammen, Norway
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Arshad N, Skjærven R, Klungsøyr K, Sørbye LM, Kvalvik LG, Morken N. Pregnancy-Associated Maternal Mortality Within One Year After Childbirth: Population-Based Cohort Study. BJOG 2025; 132:365-374. [PMID: 39440401 PMCID: PMC11704022 DOI: 10.1111/1471-0528.17985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 09/19/2024] [Accepted: 10/07/2024] [Indexed: 10/25/2024]
Abstract
OBJECTIVE The objective of this study is to assess associations between pregnancy complications and pregnancy-associated maternal mortality (PAM) within 1 year after childbirth. DESIGN Population-based cohort study. SETTING Norway, 1967-2020. POPULATION 1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967-2019 and followed in the Cause of Death Registry to 2020. METHODS Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions. MAIN OUTCOME MEASURES PAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension. RESULTS Crude OR for PAM was 4.24 (95% CI 3.53-5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08-3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20-11.72), preeclampsia: 4.42 (3.17-6.15), preterm birth: 4.32 (3.25-5.75), perinatal death: 24.18 (16.66-35.08), small for gestational age: 2.90 (1.85-4.54), gestational diabetes: 1.43 (0.63-3.25) and pregnancy hypertension: 2.05 (1.12-3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999-2019: one complication; 4.14 [2.79-6.13], two complications; 11.50 [6.81-19.43]). CONCLUSION Complications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy.
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Affiliation(s)
- Nadia Arshad
- Department of Global Public Health and Primary Care, Faculty of MedicineUniversity of BergenBergenNorway
- Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, Faculty of MedicineUniversity of BergenBergenNorway
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, Faculty of MedicineUniversity of BergenBergenNorway
- Division for Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
| | - Linn Marie Sørbye
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
- Norwegian Research Centre for Women's HealthOslo University Hospital, RikshospitaletOsloNorway
- Department of Obstetrics and GynaecologyHaukeland University HospitalBergenNorway
| | - Liv Grimstvedt Kvalvik
- Department of Global Public Health and Primary Care, Faculty of MedicineUniversity of BergenBergenNorway
| | - Nils‐Halvdan Morken
- Department of Global Public Health and Primary Care, Faculty of MedicineUniversity of BergenBergenNorway
- Department of Obstetrics and GynaecologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
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Samara A, Hanton T, Khalil A. Evidence-based interventions to address persistent maternal mortality rates. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:574-580. [PMID: 39005146 DOI: 10.1002/uog.27712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/25/2024] [Accepted: 06/07/2024] [Indexed: 07/16/2024]
Affiliation(s)
- A Samara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- FUTURE, Center for Functional Tissue Reconstruction, University of Oslo, Oslo, Norway
| | - T Hanton
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Royal College of Obstetricians and Gynaecologists, London, UK
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Lindroos L, Sengpiel V, Elden H. Experiences of implementing and working with obstetric emergency triage: A qualitative study among Swedish midwifes, auxiliary nurses, and obstetricians. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100958. [PMID: 38492272 DOI: 10.1016/j.srhc.2024.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Obstetric emergency triage is a relatively new form of emergency triage and is not yet implemented in Sweden. Adaptations enables safe assessment of the childbearing woman, fetus and labor status. Failure to identify severely ill childbearing women and women post childbirth has repeatedly led to adverse outcomes. Introducing obstetric emergency triage constitutes a profound alteration in management that may challenge preconceived notions on how to provide best care. This study aimed at exploring and describing obstetric staff's experiences of working with obstetric emergency triage. MATERIALS AND METHODS Thirteen obstetricians, midwives and auxiliary nurses at an obstetric emergency department in eastern Sweden were recruited by purposeful sampling. Individual qualitative interviews underwent inductive qualitative content analysis according to Graneheim and Lundman. RESULTS An overarching theme - A new mindset - emerged from the analysis, comprising the four categories: Implications for the individual caregiver's own work, An improved organization, Improved patient care. Initial skepticism to triage changed towards a positive attitude during implementation, identifying barriers and facilitators for successful implementation. CONCLUSIONS This first study exploring Swedish obstetric staff's perception of obstetric emergency triage as a working method suggests that, given time for implementation, a new mindset in obstetric emergency care might develop. Triage provides structure and a sense of control through a clear and quick overview of childbearing women seeking emergency care and enhances teamwork by improving communication. Triage directs attention toward aberrations and promotes reflection and action, improving patient safety.
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Affiliation(s)
- Linnéa Lindroos
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Verena Sengpiel
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Helen Elden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Essén B, Wickramasinghe A, Eriksson L, Vartanova I, Tibajev A, Strimling P. Assessing knowledge of migrant sexual reproductive health and rights: a national cross-sectional survey among health professionals in Sweden. FRONTIERS IN SOCIOLOGY 2024; 9:1356418. [PMID: 38873341 PMCID: PMC11169828 DOI: 10.3389/fsoc.2024.1356418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
Introduction Despite the commitment of the Swedish government to ensuring equal access to Sexual Reproductive Health and Rights services for all citizens, shortcomings persist among the migrant population. In cases where healthcare providers lack sufficient knowledge or hold misconceptions and biases about these contentious issues, it can lead to the delivery of suboptimal care. Therefore, the objective of this study was to assess the level of knowledge of Swedish healthcare providers on global and Swedish migrant Sexual Reproductive Health and Rights. Methods A national cross-sectional study was conducted using a questionnaire consisting of seven questions related to global and Swedish migrant Sexual Reproductive Health and Rights. The questionnaire was distributed among midwives, nurses, gynecologists and obstetricians, and hospital social workers (N = 731). The analysis was guided by the Factfulness framework developed by Hans Rosling to identify disparities between healthcare providers' viewpoints and evidence-based knowledge. Results There was an overall lack of knowledge among the health care providers on these issues. The highest correct responses were on the question on abandonment of female genital cutting/mutilation after migration (74%). The findings indicated that healthcare providers originating from Sweden, physicians, those with fewer years of clinical experience, and exhibiting more migrant-friendly attitudes, demonstrated a higher level of knowledge regarding global and Swedish migrant Sexual and Reproductive Health and Rights. Conclusion This study demonstrates that healthcare providers lacked knowledge of global and Swedish migrant Sexual Reproductive Health and Rights, which was almost uniformly distributed, except among those with more comprehensive and recent education. Contrary to expectations, healthcare professionals did not primarily rely on their education and experiences but were influenced by their personal values and opinions. The study underscores the importance of upgrading knowledge in Sexual Reproductive Health and Rights and encourages policymakers, professionals, and students to base their opinions on well-founded facts, particularly in the context of a diverse and globalized society.
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Affiliation(s)
- Birgitta Essén
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Ayanthi Wickramasinghe
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Lise Eriksson
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Faculty of Social Sciences, Business and Economics, and Law, Åbo Akademi University, Turku, Finland
| | - Irina Vartanova
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
| | - Andrey Tibajev
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
| | - Pontus Strimling
- Department of Women’s and Children’s Health, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
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Aldo C, Martina Z, Alberto A, Mario P. Cardiovascular risk evaluation in pregnancy: focus on cardiac specific biomarkers. Clin Chem Lab Med 2024; 62:581-592. [PMID: 37942796 DOI: 10.1515/cclm-2023-0609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
Despite the evidence demonstrating the clinical utility of cardiac specific biomarkers in improving cardiovascular risk evaluation in several clinical conditions, even the most recent reviews and guidelines fail to consider their measurement in order to enhance the accuracy of the evaluation of cardiovascular risk in pregnant women. The aim of this review article was to examine whether the assay of cardiac specific biomarkers can enhance cardiovascular risk evaluation in pregnant women, first by reviewing the relationships between the physiological state of pregnancy and cardiac specific biomarkers. The clinical relevance of brain natriuretic peptide (BNP)/NT-proBNP and high-sensitivity cardiac troponin I/high-sensitivity cardiac troponin T (hs-cTnI/hs-cTnT) assay in improving cardiovascular risk evaluation is examined based on the results of clinical studies on subjects with normal and those with complicated pregnancy. Finally, the analytical approaches and clinical objectives related to cardio specific biomarkers are advocated in order to allow an early and more accurate evaluation of cardiovascular risk in pregnant women.
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Affiliation(s)
- Clerico Aldo
- Coordinator of the Study Group on Cardiac Biomarkers from Italian Society of Biochemical Chemistry (SIBioC) and European Ligand Assay Society (ELAS), Milan, Italy
| | - Zaninotto Martina
- Department of Laboratory Medicine, University-Hospital Padova, Padova, Italy
| | - Aimo Alberto
- Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | - Plebani Mario
- Department of Medicine, University of Padova, Padova, Italy
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Vest T, Rantanen K, Verho L, Aarnio K, Korhonen A, Richardt A, Strbian D, Gissler M, Laivuori H, Tikkanen M, Ijäs P. Etiology of intracerebral hemorrhage during pregnancy or puerperium: A nationwide study. Eur J Neurol 2024; 31:e16012. [PMID: 37532682 PMCID: PMC11235636 DOI: 10.1111/ene.16012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage during pregnancy or puerperium (pICH) is one of the leading causes of maternal death worldwide. However, limited epidemiological data exist on the etiology and outcomes of pICH, which is required to guide prevention and treatment. METHODS A retrospective nationwide cohort study and a nested case-control study was performed in Finland 1987-2016. We identified women with incident pICH by linking the Medical Birth Register (MBR) and the Hospital Discharge Register (HDR). The clinical details were collected from patient records. Three matched controls with a pregnancy without ICH were selected for each case from the MBR. RESULTS In total, 49 pICH cases were identified. Half of these cases occurred during pregnancy, and the other half during peripartum and puerperium. Based on the SMASH-U (structural vascular lesion, medication, amyloid angiopathy, systemic disease, hypertension, undetermined) classification, 35.4% of the patients had a systemic disease, most commonly preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome; 31.3% had a structural vascular lesion; 31.3% had an undetermined etiology; and one patient (2.1%) had hypertension. The most important risk factor was hypertensive disorders of pregnancy (HDP; odds ratio = 3.83, 95% confidence interval = 1.60-9.15), occurring in 31% of the cases. Maternal mortality was 12.5%, and 20.9% of the surviving women had significant disability (modified Rankin Scale = 3-5) 3 months after the pICH. Women with systemic disease had the worst outcomes. CONCLUSIONS Even in a country with a comprehensive pregnancy surveillance system, the maternal mortality rate for pICH is high, and the sequelae are severe. Early recognition and treatment of the key risk factor, HDP, is crucial to help prevent this serious pregnancy complication.
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Affiliation(s)
- Teresa Vest
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Kirsi Rantanen
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Liisa Verho
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Karoliina Aarnio
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Aino Korhonen
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Anna Richardt
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Daniel Strbian
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Mika Gissler
- Department of Knowledge BrokersFinnish Institute for Health and WelfareHelsinkiFinland
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Region StockholmAcademic Primary Health Care CentreStockholmSweden
| | - Hannele Laivuori
- Medical and Clinical GeneticsUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life ScienceUniversity of HelsinkiHelsinkiFinland
- Department of Obstetrics and GynecologyTampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research TampereTampereFinland
| | - Minna Tikkanen
- Department of Obstetrics and GynecologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Petra Ijäs
- Department of NeurologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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Chrzan-Dętkoś M, Murawska N, Łockiewicz M, de la Fe Rodriguez Muñoz M. Self-harm thoughts among postpartum women - associated factors. J Reprod Infant Psychol 2024:1-14. [PMID: 38319751 DOI: 10.1080/02646838.2024.2313487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. AIM We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. METHOD 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. RESULTS Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. CONCLUSION The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.
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Affiliation(s)
| | - Natalia Murawska
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
| | - Marta Łockiewicz
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
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Ahmed SMA, Cresswell JA, Say L. Incompleteness and misclassification of maternal death recording: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:794. [PMID: 37968585 PMCID: PMC10647144 DOI: 10.1186/s12884-023-06077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
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.
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Affiliation(s)
- Sahar M A Ahmed
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland.
| | - Jenny A Cresswell
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
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10
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Peeyananjarassri K, Ratipann N, Suwanrath C, Pinjaroen S, Chainarong N, Choobun T. An in-depth analysis of maternal mortality in a quaternary university hospital in Southern Thailand: A 16-year experience. Int J Gynaecol Obstet 2023; 163:579-585. [PMID: 37177786 DOI: 10.1002/ijgo.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To perform an in-depth analysis and evaluate the causes of maternal deaths in a university hospital in Southern Thailand. METHODS A retrospective descriptive study was conducted. Medical records of all women who died during pregnancy or within 42 days of termination of pregnancy at Songklanagarind Hospital from January 2006 to December 2021 were reviewed. RESULTS There were 51 910 live births during the 16-year period and 68 maternal deaths (31 of direct cause, 36 of indirect cause, and one of unknown cause). The maternal mortality ratio was 131 per 100 000 live births. There was a decreasing trend in the maternal mortality ratio, especially during the past 4 years. The leading causes of death were cardiac disease (n = 17), hypertensive disorders in pregnancy (n = 9), and postpartum hemorrhage (n = 7). The most common indirect causes of maternal death were cardiac disease, hematologic disease, and dengue hemorrhagic fever. There was a decreasing trend in indirect to direct deaths ratios during three study periods. Ratios in 2006 to 2010, 2011 to 2015, and 2016 to 2021 were 1.6, 1.4, and 0.5, respectively. CONCLUSIONS The three leading causes of death were cardiac disease, hypertensive disorders in pregnancy, and postpartum hemorrhage. Improvements in the quality of obstetric care at all hospital levels are required.
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Affiliation(s)
- Krantarat Peeyananjarassri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ninizna Ratipann
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sutham Pinjaroen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Natthicha Chainarong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thanapan Choobun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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de Vries PLM, van den Akker T, Bloemenkamp KWM, Grossetti E, Rigouzzo A, Saucedo M, Verspyck E, Zwart J, Deneux-Tharaux C. Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care. Int J Gynaecol Obstet 2023; 162:1077-1085. [PMID: 37177815 DOI: 10.1002/ijgo.14829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. METHODS In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. RESULTS For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. CONCLUSION A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.
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Affiliation(s)
- P L M de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Grossetti
- Department of Obstetrics, Hospital group du Havre, Le Havre, France
| | - A Rigouzzo
- Department of Anesthesiology, Armand Trousseau Children's Hospital, Paris, France
| | - M Saucedo
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| | - E Verspyck
- Department of Obstetrics and Gynaecology, University Hospital of Rouen, Rouen, France
| | - J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - C Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
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12
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Pettersen S, Falk RS, Vangen S, Nyfløt LT. Exploring trends of severe postpartum haemorrhage: a hospital-based study. BMC Pregnancy Childbirth 2023; 23:363. [PMID: 37208647 DOI: 10.1186/s12884-023-05702-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Over the past two decades several high-income countries have reported increased rates of postpartum haemorrhage (PPH). Many of the studies are registry studies with limited access to detailed information. We aimed to explore trends of severe PPH in the largest labour ward in Norway during a 10-year period with a hospital based study. Our population constituted all women who gave birth after week 22 at Oslo University Hospital between 2008 and 2017. The main outcome measure was severe PPH, defined as registered blood loss greater than 1500 ml, or transfusion of blood products due to PPH. METHODS We estimated the incidence of severe PPH and blood transfusions, and performed temporal trend analysis. We performed Poisson regression analysis to investigate associations between pregnancy characteristics and severe PPH, presented using crude incidence rate ratios (IRR) with 95% confidence intervals (CI)s. We also estimated annual percentage change of the linear trends. RESULTS Among 96 313 deliveries during the 10-year study period, 2621 (2.7%) were diagnosed with severe PPH. The incidence rate doubled from 17.1/1000 to 2008 to 34.2/1000 in 2017. We also observed an increased rate of women receiving blood transfusion due to PPH, from 12.2/1000 to 2008 to 27.5/1000 in 2017. The rates of invasive procedures to manage severe PPH did not increase, and we did not observe a significant increase in the number of women defined with maternal near miss or massive transfusions. No women died due to PPH during the study period. CONCLUSION We found a significant increasing trend of severe PPH and related blood transfusions during the 10-year study period. We did not find an increase in massive PPH, or in invasive management, and we suspect that the rise can be at least partly explained by increased awareness and early intervention contributing to improved registration of severe PPH.
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Affiliation(s)
- Silje Pettersen
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Box 4959, Nydalen, Oslo, 0424, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Box 4959, Nydalen, Oslo, 0424, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lill Trine Nyfløt
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Box 4959, Nydalen, Oslo, 0424, Norway
- Department of Obstetrics, Drammen Hospital, Drammen, Norway
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13
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Edwards P, Anyaogu C, Mezue K, Baugh D, Goha A, Egbuche O, Nunura F, Madu E. Focused cardiac ultrasound in pregnancy. J Investig Med 2023; 71:81-91. [PMID: 36691704 DOI: 10.1177/10815589221142195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.
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Affiliation(s)
- Paul Edwards
- Heart Institute of the Caribbean, Kingston, Jamaica
| | | | - Kenechukwu Mezue
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Dainia Baugh
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ahmed Goha
- Cardiology department, Cardiac Center Hail, Hail, Saudi Arabia
| | - Obiora Egbuche
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Felix Nunura
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ernest Madu
- Heart Institute of the Caribbean, Kingston, Jamaica
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14
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Diguisto C, Saucedo M, Kallianidis A, Bloemenkamp K, Bødker B, Buoncristiano M, Donati S, Gissler M, Johansen M, Knight M, Korbel M, Kristufkova A, Nyflot LT, Deneux-Tharaux C. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study. BMJ 2022; 379:e070621. [PMID: 36384872 PMCID: PMC9667469 DOI: 10.1136/bmj-2022-070621] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare maternal mortality in eight countries with enhanced surveillance systems. DESIGN Descriptive multicountry population based study. SETTING Eight countries with permanent surveillance systems using enhanced methods to identify, document, and review maternal deaths. The most recent available aggregated maternal mortality data were collected for three year periods for France, Italy, and the UK and for five year periods for Denmark, Finland, the Netherlands, Norway, and Slovakia. POPULATION 297 835 live births in Denmark (2013-17), 301 169 in Finland (2008-12), 2 435 583 in France (2013-15), 1 281 986 in Italy (2013-15), 856 572 in the Netherlands (2014-18), 292 315 in Norway (2014-18), 283 930 in Slovakia (2014-18), and 2 261 090 in the UK (2016-18). OUTCOME MEASURES Maternal mortality ratios from enhanced systems were calculated and compared with those obtained from each country's office of vital statistics. Age specific maternal mortality ratios; maternal mortality ratios according to women's origin, citizenship, or ethnicity; and cause specific maternal mortality ratios were also calculated. RESULTS Methods for identifying and classifying maternal deaths up to 42 days were very similar across countries (except for the Netherlands). Maternal mortality ratios up to 42 days after end of pregnancy varied by a multiplicative factor of four from 2.7 and 3.4 per 100 000 live births in Norway and Denmark to 9.6 in the UK and 10.9 in Slovakia. Vital statistics offices underestimated maternal mortality by 36% or more everywhere but Denmark. Age specific maternal mortality ratios were higher for the youngest and oldest mothers (pooled relative risk 2.17 (95% confidence interval 1.38 to 3.34) for women aged <20 years, 2.10 (1.54 to 2.86) for those aged 35-39, and 3.95 (3.01 to 5.19) for those aged ≥40, compared with women aged 20-29 years). Except in Norway, maternal mortality ratios were ≥50% higher in women born abroad or of minoritised ethnicity, defined variously in different countries. Cardiovascular diseases and suicides were leading causes of maternal deaths in each country. Some other conditions were also major contributors to maternal mortality in only one or two countries: venous thromboembolism in the UK and the Netherlands, hypertensive disorders in the Netherlands, amniotic fluid embolism in France, haemorrhage in Italy, and stroke in Slovakia. Only two countries, France and the UK, had enhanced methods for studying late maternal deaths, those occurring between 43 and 365 days after the end of pregnancy. CONCLUSIONS Variations in maternal mortality ratios exist between high income European countries with enhanced surveillance systems. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.
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Affiliation(s)
- Caroline Diguisto
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, 37 044 Tours, France; Université de Tours, 37032 Tours, France
| | - Monica Saucedo
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Athanasios Kallianidis
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Marta Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Miroslav Korbel
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Alexandra Kristufkova
- 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Lill T Nyflot
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Department of Obstetrics, Drammen Hospital, Drammen, Norway
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
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15
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Heemelaar S, Agapitus N, van den Akker T, Stekelenburg J, Mackenzie S, Hugo‐Hamman C, Auala T. Experiences of a dedicated Heart and Maternal Health Service providing multidisciplinary care to pregnant women with cardiac disease in a tertiary centre in Namibia. Trop Med Int Health 2022; 27:803-814. [PMID: 36053884 PMCID: PMC9543594 DOI: 10.1111/tmi.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES First, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population. METHODS In a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high-income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018. RESULTS Important benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower-income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre-existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9-38.0). Five women died. Cardiac events occurred in twenty-two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35/65, 53.8%) were using long-acting reversible contraception. CONCLUSIONS Despite several barriers, it was possible to implement a multidisciplinary service in a high-burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context-specific guidelines and better detection of cardiac disease.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics & GynaecologyWindhoek Central HospitalWindhoekNamibia
- Department of Obstetrics and GynaecologyLeidenThe Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics and GynaecologyLeidenThe Netherlands
- Athena InstituteVU UniversityAmsterdamThe Netherlands
| | - Jelle Stekelenburg
- Department of Health SciencesUniversity Medical Center GroningenGroningenThe Netherlands
- Department of Obstetrics and GynaecologyMedical Center LeeuwardenLeeuwardenThe Netherlands
| | - Shonag Mackenzie
- Department of Obstetrics & GynaecologyWindhoek Central HospitalWindhoekNamibia
| | | | - Tangeni Auala
- Department of CardiologyWindhoek Central HospitalWindhoekNamibia
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Hossain N, Shaikh ZF. Maternal deaths due to indirect causes: Report from a tertiary care center of a developing country. Obstet Med 2022; 15:176-179. [PMID: 36262822 PMCID: PMC9574443 DOI: 10.1177/1753495x211037916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 09/03/2023] Open
Abstract
Objective To assess the causes of indirect maternal deaths. Setting The Department of Obstetrics & Gynecology, of a tertiary referral center in Karachi, Pakistan, from January 2018 to December 2020. Maternal deaths were categorized according to World Health Organization guidelines into direct and indirect deaths. Result The total maternal deaths during the study period were 96, with 26 (27%) due to indirect causes. The mean age in the indirect group was 27 (range: 20-35) years, with only eight (31%) registered (attending for three of more antenatal visits). The mean gestational age was 33 (range: 22-39) weeks. Cesarean section was the main mode of delivery, in 13 (50%). Perinatal mortality was 68%. Cardiac and hepatic diseases (each six deaths, 23%) were the main causes of indirect maternal deaths. The majority of women (20; 76%) died during the postpartum period. Delays in seeking medical help, referral, and appropriate treatment were observed in 10, 9, and 7 cases, respectively. Conclusion Indirect maternal deaths are an important cause of maternal mortality.
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Affiliation(s)
- Nazli Hossain
- Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital & Dow
Medical College, Pakistan
| | - Zeenat F Shaikh
- Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital & Dow
Medical College, Pakistan
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17
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Karalexi MA, Eberhard-Gran M, Valdimarsdóttir UA, Karlsson H, Munk-Olsen T, Skalkidou A. Perinatal mental health: how nordic data sources have contributed to existing evidence and future avenues to explore. Nord J Psychiatry 2022; 76:423-432. [PMID: 35057712 DOI: 10.1080/08039488.2021.1998616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Perinatal mental health disorders affect a significant number of women with debilitating and potentially life-threatening consequences. Researchers in Nordic countries have access to high quality, population-based data sources and the possibility to link data, and are thus uniquely positioned to fill current evidence gaps. We aimed to review how Nordic studies have contributed to existing evidence on perinatal mental health. METHODS We summarized examples of published evidence on perinatal mental health derived from large population-based longitudinal and register-based data from Denmark, Finland, Iceland, Norway and Sweden. RESULTS Nordic datasets, such as the Danish National Birth Cohort, the FinnBrain Birth Cohort Study, the Icelandic SAGA cohort, the Norwegian MoBa and ABC studies, as well as the Swedish BASIC and Mom2B studies facilitate the study of prevalence of perinatal mental disorders, and further provide opportunity to prospectively test etiological hypotheses, yielding comprehensive suggestions about the underlying causal mechanisms. The large sample size, extensive follow-up, multiple measurement points, large geographic coverage, biological sampling and the possibility to link data to national registries renders them unique. The use of novel approaches, such as the digital phenotyping data in the novel application-based Mom2B cohort recording even voice qualities and digital phenotyping, or the Danish study design paralleling a natural experiment are considered strengths of such research. CONCLUSIONS Nordic data sources have contributed substantially to the existing evidence, and can guide future work focused on the study of background, genetic and environmental factors to ultimately define vulnerable groups at risk for psychiatric disorders following childbirth.
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Affiliation(s)
- Maria A Karalexi
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unnur Anna Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hasse Karlsson
- Department of Psychiatry and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Trine Munk-Olsen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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18
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Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras medical college pregnancy and cardiac disease (M-PAC) registry. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Reid HE, Pratt D, Edge D, Wittkowski A. Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors. Front Psychiatry 2022; 13:765118. [PMID: 35401283 PMCID: PMC8987004 DOI: 10.3389/fpsyt.2022.765118] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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20
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Maternal mortality trends in Spain during the 2000-2018 period: the role of maternal origin. BMC Public Health 2022; 22:337. [PMID: 35177052 PMCID: PMC8851759 DOI: 10.1186/s12889-022-12686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background The available literature indicates that there are significant differences in maternal mortality according to maternal origin in high income countries. The aim of this study was to examine the trend in the maternal mortality rate and its most common causes in Spain in recent years and to analyse its relationship with maternal origin. Methods This was a cross-sectional study of all live births as well as those resulting in maternal death in Spain during the period between 2000 and 2018. A descriptive analysis of the maternal mortality rate by cause, region of birth, maternal age, marital status, human development index and continent of maternal origin was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analyses, with adjustment for certain variables included in the descriptive analysis. Results There was a total of 293 maternal deaths and 8,439,324 live births during the study period. The most common cause of maternal death was hypertensive disorders of pregnancy. The average maternal death rate was 3.47 per 100,000 live births. The risk of suffering from this complication was higher for immigrant women from less developed countries. The adjusted effect of maternal HDI score over maternal mortality was OR = 0.976; 95% CI 0.95 – 0.99; p = 0.048; therefore, a decrease of 0.01 in the maternal human development index score significantly increased the risk of this complication by 2.4%. Conclusions The results of this study indicate that there are inequalities in maternal mortality according to maternal origin in Spain. The human development index of the country of maternal origin could be a useful tool when estimating the risk of this complication, taking into account the origin of the pregnant woman.
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Gnanaraj JP, Princy SA, Sliwa-Hahnle K, Sathyendra S, Jeyabalan N, Sethumadhavan R, G S, Sumathi N, S V, P P, Murali V, B S, T G, P M, Jeemon P, Elavarasi E, R R, S V, K K. Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR): design and methodology. BMC Pregnancy Childbirth 2022; 22:80. [PMID: 35093002 PMCID: PMC8801092 DOI: 10.1186/s12884-021-04305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cardiac disease in pregnancy is a major contributor to maternal mortality in high, middle and low-income countries. Availability of data on outcomes of pregnancy in women with heart disease is important for planning resources to reduce maternal mortality. Prospective data on outcomes and risk predictors of mortality in pregnant women with heart disease (PWWHD) from low- and middle-income countries are scarce.
Methods
The Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR) is a prospective, multicentric and multidisciplinary registry of PWWHD from 29 participating sites including both public and private sectors, across the state of Tamil Nadu in India. The TNPHDR is aimed to provide data on incidence of maternal and fetal outcomes, adverse outcome predictors, applicability of the modified World Health Organization (mWHO) classification of maternal cardiovascular risk and the International risk scoring systems (ZAHARA and CARPREG I & II) in Indian population and identify possible gaps in the existing management of PWWHD. Pregnancy and heart teams will be formed in all participating sites. Baseline demographic, clinical, laboratory and imaging parameters, data on counselling received, antenatal triage and management, peripartum management and postpartum care will be collected from 2500 eligible participants as part of the TNPHDR. Participants will be followed up at one, three and six-months after delivery/termination of pregnancy to document study outcomes. Predictors of maternal and foetal outcome will be identified.
Discussion
The TNPHDR will be the first representative registry from low- and middle-income countries aimed at providing crucial information on pregnancy outcomes and risk predictors in PWWHD. The results of TNPHDR could help to formulate steps for improved care and to generate a customised and practical guideline for managing pregnancy in women with heart disease in limited resource settings.
Trial registration
The TNPHDR is registered under Clinical Trials Registry-India (CTRI/2020/01/022736).
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22
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Schier de Fraga F, Wan-Dall BSL, Garcia GHDO, Pandolfo H, Sequinel AMTDS, Alvin P, Serman EJ, do Amaral VF. Antenatal screening of depressive and manic symptoms in south Brazilian childbearing women: A transversal study in advance of the pandemic scenario. PLoS One 2021; 16:e0261874. [PMID: 34962942 PMCID: PMC8714122 DOI: 10.1371/journal.pone.0261874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background The diagnosis of mood disorders (MD) during pregnancy is challenging and may bring negative consequences to the maternal-fetal binomial. The long waitlist for specialized psychiatric evaluation in Brazil contributes to the treatment omission. Almost 20.0% of women treated with antidepressants have a positive screening for bipolar disorder. Therefore, it has been recommended the investigation of depressive and bipolar disorder during prenatal care. Unfortunately, the screening for mood disorders is not a reality in Brazil and many childbearing women remain undiagnosed. The objective of this study is to observe the frequency of MD and the effectiveness of screening scales for routine use by health professionals during prenatal care in high-risk pregnancies. Methodology/Principal findings This cross-sectional study included 61 childbearing women in their second trimester who were interviewed using the Edinburgh Postnatal Depression Scale (EPDS) and the Mood Disorder Questionnaire (MDQ). The cut-off point was EPDS ≥ 13 and MDQ ≥ 7 and the SCID-5 was the gold standard diagnosis. MD were diagnosed in 24.6% of the high-risk pregnancies. EDPS was positive in 19.7% and the frequency of major depression was 8.2%. 16.4% of the childbearing women were diagnosed with bipolar disorder, while MDQ was positive in 36.1%. 11.5% of the women had EPDS and MDQ positive. EPDS sensitivity was 80.0% and specificity 92.1%, whereas MDQ presented a sensitivity of 70.0% and specificity of 70.6%. Conclusion/Significance There is a high prevalence of MD in high-risk pregnancies. The routine use of EPDS simultaneously to MDQ during antenatal care is effective and plays an important role in early diagnosis, counselling, and promotion of perinatal mental health.
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Affiliation(s)
- Fernanda Schier de Fraga
- Department of Obstetrics and Gynaecology, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
- * E-mail:
| | | | | | - Henrique Pandolfo
- Department of Psychiatry, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
| | | | - Pedro Alvin
- Department of Psychiatry, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
| | - Eduardo Jonson Serman
- Department of Obstetrics and Gynaecology, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
| | - Vivian Ferreira do Amaral
- Department of Obstetrics and Gynaecology, Health Science Sector of Federal University of Parana, Curitiba, Parana, Brazil
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Lindroos L, Korsoski R, Öhman MO, Elden H, Karlsson O, Sengpiel V. Improving assessment of acute obstetric patients - introducing a Swedish obstetric triage system. BMC Health Serv Res 2021; 21:1207. [PMID: 34742302 PMCID: PMC8572438 DOI: 10.1186/s12913-021-07210-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Failure to identify severely ill obstetric patients seeking acute care, and hence delaying treatment, can lead to maternal morbidity and mortality. Triage is the prioritization of patients seeking emergency care, based on clinical decision-making tools assessing medical urgency. While triage has been applied in general emergency medicine for 30 years, there are only a few obstetric triage systems (OTS) and obstetric triage has hitherto been unknown in Sweden. Obstetric triage is more complex than general triage since both mother and fetus require assessment, and pregnancy-related physiological changes must be taken into account. This paper aims to describe the development and an initial evaluation of the first OTS in Sweden. METHODS A multidisciplinary team surveyed reasons to seek acute obstetric care and the current patient flow at the largest obstetric unit in Scandinavia, Sahlgrenska University Hospital, Gothenburg, Sweden, with about 10,000 deliveries/year. A semi-structured literature review on obstetric triage was undertaken. Based on the survey and the literature review the first Swedish OTS was developed and implemented. Patient satisfaction was followed by electronical questionnaires. Initial validity evaluation was performed, defined by the system's ability to identify patients with need for hospital admission, stratified by acuity level. RESULTS The Gothenburg Obstetrical Triage System (GOTS) addresses the patient to one of five acuity levels based on both vital signs and 14 chief complaint algorithms. It entails recommendations for initial procedures of care as well as an acuity form for documentation. Initial evaluation of the system indicates good correlation between need for admission and acuity level. The implementation has provided the staff with an improved medical overview of the patients and patient flow and enabled the unit to monitor emergency care in a structured way. Implementation came along with increased patient and staff satisfaction. CONCLUSION The GOTS is the first OTS developed in and for Sweden and implementation has improved management of obstetric patients seeking acute care. Patients are now prioritized according to level of acuity and the time to assessment and treatment of severely ill patients can be structurally evaluated. Both patients and staff express improved satisfaction with obstetric triage.
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Affiliation(s)
- Linnéa Lindroos
- Department of Obstetrics, Sahlgrenska University Hospital/Östra, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden.
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Radha Korsoski
- Department of Obstetrics, Sahlgrenska University Hospital/Östra, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden
| | - Marie Ordéus Öhman
- Department of Obstetrics, Sahlgrenska University Hospital/Östra, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden
| | - Helen Elden
- Department of Obstetrics, Sahlgrenska University Hospital/Östra, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden
- Institution of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ove Karlsson
- NU Hospital Group, Trollhättan, Sweden
- Department of Anesthesiology and Intensive Care, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics, Sahlgrenska University Hospital/Östra, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lindroos L, Elden H, Karlsson O, Sengpiel V. An interrater reliability study on the Gothenburg obstetric triage system- a new obstetric triage system. BMC Pregnancy Childbirth 2021; 21:668. [PMID: 34600512 PMCID: PMC8487102 DOI: 10.1186/s12884-021-04136-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Triage, identifying patients with critical and time-sensitive disorders, is an integrated process in general emergency medicine. Obstetric triage is more specialised, requiring assessment of both woman, fetus and labour status. Failure to identify severely ill obstetric patients has repeatedly led to maternal morbidity and mortality. Reliable triage systems, adapted to obstetric patients as well as local conditions, are thus essential. The study aims to assess the interrater reliability (IRR) of the Gothenburg Obstetric Triage System (GOTS). METHODS Midwives (n = 6) and registered nurses with no experience in managing obstetric patients (n = 7), assessed 30 paper cases based on actual real-life cases, using the GOTS. Furthermore, a reference group consisting of two midwives and two obstetricians, with extensive experience in obstetric care, determined the correct triage level in order to enable analysis of over- and undertriage. IRR was assessed, both with percentage of absolute agreement and with intra-class correlation coefficients (ICC) with 95% confidence intervals (CI). RESULTS A total of 388 assessments were performed, comprising all five levels of acuity in the GOTS. Absolute agreement was found in 69.6% of the assessments. The overall IRR was good, with a Kappa value of 0.78 (0.69-0.87, 95% CI) for final triage level. Comparison with reference group assessments established that over- and undertriage had occurred in 9% and 21% of the cases, respectively. The main reasons for undertriage were "not acknowledging abnormal vital sign parameters" and "limitations in study design". CONCLUSION The GOTS is a reliable tool for triaging obstetric patients. It enables a standardized triage process unrelated to the assessors' level of experience in assessing and managing obstetric patients and is applicable for triaging obstetric patients presenting for emergency care at obstetric or emergency units.
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Affiliation(s)
- Linnéa Lindroos
- Region Västra Götaland, Sahlgrenska University Hospital, Department of obstetrics and gynaecology, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden.
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Helen Elden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of obstetrics and gynaecology, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ove Karlsson
- Region Västra Götaland, NU Hospital Group, Department of Anaesthesiology and Intensive Care, Trollhättan, Sweden
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Region Västra Götaland, Sahlgrenska University Hospital, Department of obstetrics and gynaecology, Diagnosvägen 15, Paviljong 7b, 416 50, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Leonardsen ACL, Helgesen AK, Ulvøy L, Grøndahl VA. Prehospital assessment and management of postpartum haemorrhage- healthcare personnel's experiences and perspectives. BMC Emerg Med 2021; 21:98. [PMID: 34454430 PMCID: PMC8403351 DOI: 10.1186/s12873-021-00490-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH assessment and management is essential in prehospital personnel. The objective was to explore prehospital personnel's competence in PPH and AC, utilizing different tools. METHODS The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n = 250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as tool developed utilizing the Delphi technique. Descriptive statistics were used to analyze the quantitative data, while quantitative content analysis was used to analyse free-text responses. RESULTS A total of 87 prehospital personnel responded to the questionnaire, 57.5% male, mean age 37.9 years. In total, 80.4% were ambulance workers and/or paramedics, and 96.6 and 97.7% respectively reported to need more education or training in PPH. Moreover, 82.8% reported having managed patient(s) with PPH, but only 2.9% had performed AC. Prehospital personnels' responses varied extensively regarding knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8. CONCLUSIONS This study indicates that prehospital personnel lack knowledge about PPH and AC, due to various responses to the developed questionnaire. Even though AC is an acknowledged intervention in PPH, few participants reported that this was utilized. Our findings emphasize the need for education and training in PPH and PPH handling generally, and in AC specifically.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
- Ostfold Hospital Trust, Department of Anesthesia, 300 NO-1714 Grålum, PB Norway
| | - Ann Karin Helgesen
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
| | - Linn Ulvøy
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
- Ostfold Hospital Trust, Prehospital Department, 300 NO-1714 Grålum, PB Norway
| | - Vigdis Abrahamsen Grøndahl
- Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757 Halden, Norway
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Stålberg V, Josefsson A, Bladh M, Lilliecreutz C. The risk of postpartum hemorrhage when lowering the oxytocin dose in planned cesarean section, a pilot study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100641. [PMID: 34174496 DOI: 10.1016/j.srhc.2021.100641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Oxytocin is the drug of choice in preventing postpartum hemorrhage (PPH). The aim was to compare the peroperative- and total blood loss within two hours and PPH after planned cesarean section (CS) when receiving 2.5 IU vs 5.0 IU of oxytocin in different risk groups for PPH. STUDY DESIGN A pilot study including 927 women undergoing planned CS where women receiving 2.5 IU of oxytocin were compared to women receiving 5.0 IU of oxytocin. MAIN OUTCOME MEASURES Data comparing peroperative blood loss, total blood loss within two hours and PPH were analyzed. RESULTS The women receiving 2.5 IU of oxytocin had a slightly higher peroperative blood loss, compared to the 5.0 IU group (476 ml vs 426 ml, p = 0.029). The total blood loss two hours after surgery showed no significant difference between the groups (626 ml vs 595 ml, p = 0.230). In the 2.5 IU group 13% had a blood loss ≥ 1000 ml vs 10% in the 5 IU group (aOR 1.64, 95% CI = 1.05-2.56). When the women considered to be at high risk for postpartum hemorrhage were excluded, we found no difference in the likelihood for postpartum hemorrhage between the groups (aOR 1.13, 95% CI = 0.64-1.99). CONCLUSIONS Women undergoing planned CS and receiving 2.5 IU of oxytocin had a slightly higher risk for postpartum hemorrhage in this study. However, a lower dose of 2.5 IU of oxytocin seems to be a safe option in planned CS for women without known risk factors for postpartum hemorrhage, but further research is needed to confirm these findings.
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Affiliation(s)
- Valerie Stålberg
- Department of Obstetrics and Gynecology in Norrköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.
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Karjalainen L, Tikkanen M, Rantanen K, Aarnio K, Korhonen A, Saaros A, Laivuori H, Gissler M, Ijäs P. Stroke in Pregnancy and Puerperium: Validated Incidence Trends With Risk Factor Analysis in Finland 1987-2016. Neurology 2021; 96:e2564-e2575. [PMID: 33827961 DOI: 10.1212/wnl.0000000000011990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS. METHODS We performed a retrospective population-based cohort study and nested case-control study in Finland from 1987 to 2016. The Medical Birth Register (MBR) was linked to the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period in 5-year age groups and pregnancy/postpartum period was calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors. RESULTS After chart review, 29.6% (257 of 868) of cases were PAS. The incidence of PAS was 14.5 (95% confidence interval [CI] 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987 to 1991 to 2012 to 2016 (p < 0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from 20 to 24 years to >40 years of age (p < 0.0001). During the early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable-adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95% CI 1.2-2.7), migraine (OR 16.3, 95% CI 5.3-49.8), and hypertensive disorders of pregnancy (OR 4.0, 95% CI 2.5-6.3) were the most important risk factors for PAS. CONCLUSION PAS incidence is increasing, stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine, and hypertensive disorders of pregnancy are associated with an increased risk of PAS.
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Affiliation(s)
- Liisa Karjalainen
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Minna Tikkanen
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Kirsi Rantanen
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Karoliina Aarnio
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Aino Korhonen
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Anna Saaros
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hannele Laivuori
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mika Gissler
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Petra Ijäs
- From Neurology (L.K., K.R., K.A., A.K., A.S., P.I.), Obstetrics and Gynecology (M.T.), and Medical and Clinical Genetics (H.L.), University of Helsinki and Helsinki University Hospital; Obstetrics and Gynecology (L.K.), University of Helsinki and Hyvinkää Hospital, Helsinki University Hospital, Hyvinkää/Helsinki; Institute for Molecular Medicine Finland (H.L.), Helsinki Institute of Life Science, University of Helsinki; Department of Obstetrics and Gynecology (H.L.), Tampere University Hospital; Faculty of Medicine and Health Technology (H.L.), Tampere University; Department of Information Services (M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; and Department of Neurobiology (M.G.), Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Wakasa T, Ishibashi‐Ueda H, Takeuchi M. Maternal death analysis based on data from the nationwide registration system in Japan (2010-2018). Pathol Int 2021; 71:223-231. [PMID: 33559265 PMCID: PMC8248185 DOI: 10.1111/pin.13076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Between January 2010 and April 2018, 367 maternal deaths were reported. Among them, by reviewing 80 autopsy records, the direct obstetric causes of death were identified in 52 women. The major causes of deaths were amniotic fluid embolism and acute pulmonary thromboembolism. The other 26 maternal deaths were associated with indirect obstetric causes including invasive Group A Streptococcus infection, aortic dissection, cerebral stroke and cardiomyopathies. This review highlights the importance of autopsy in maternal deaths. On analyzing 42 autopsy specimens obtained from registered cases of maternal death during 2012-2015, the 36% of causes of death by autopsy were discordant with the clinical diagnosis. Moreover, of the 38% of non-autopsied maternal death, the cause of death could not be clarified from the clinical chart. We emphasized that detailed autopsies are necessary to clarify the precise pathologic evidence related to pregnancy and delivery, especially causes of unexpected death such as amniotic fluid embolism.
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Affiliation(s)
- Tomoko Wakasa
- Department of Diagnostic Pathology, Nara HospitalKindai UniversityNaraJapan
| | | | - Makoto Takeuchi
- Department of PathologyOsaka Women's and Children's HospitalOsakaJapan
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Berdzuli N, Lomia N, Staff AC, Lazdane G, Pestvenidze E, Jacobsen AF. Audit of Early and Late Maternal Deaths in Georgia: Potential for Improving Substandard Obstetric Care. Int J Womens Health 2021; 13:205-219. [PMID: 33628061 PMCID: PMC7899038 DOI: 10.2147/ijwh.s288763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Quality of care is an important factor in reducing preventable maternal deaths, yet it is a significant challenge in many countries. Substandard and poor quality of care is the leading factor in two-thirds of maternal deaths in European countries. Our study investigated the deaths of all women of reproductive age in 2012 in Georgia. The aim was to define the underlying causes of maternal deaths and to identify the factors in women’s care which contributed to the fatal outcomes. Methods A national Reproductive Age Mortality Survey was conducted in Georgia in 2014–15. Data from multiple sources was triangulated to identify all deaths of women of reproductive age. This was followed by verbal autopsy diagnoses. Each case of early and late maternal death was investigated through interviews and medical record reviews at the last medical facility providing care for the deceased woman. A specialist panel reviewed and assigned underlying causes of death, assessed the management of each woman’s condition, and identified elements of suboptimal care. Results We identified a total of 23 maternal deaths, including 15 (65%) early and eight (35%) late deaths. The maternal mortality ratio was 26.3 per 100 000 live births. The four leading causes of early maternal deaths were: sepsis, hemorrhage, embolism, and pregnancy-induced hypertension. Embolism and sepsis were the direct causes of the eight late maternal deaths. Cancer, tuberculosis, and postpartum suicide constituted the indirect causes of death. Improvements in care which would have made a difference to the outcomes were identified in 87% of early maternal deaths and 67% of late maternal deaths due to direct obstetric causes. Discussion Delayed recognition and inappropriate management of maternal complications were common across almost all cases studied. The findings from Georgia highlight the conclusion that most maternal deaths were preventable and that improvement in obstetric care is urgently required.
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Affiliation(s)
- Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunta Lazdane
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Nyfløt LT, Johansen M, Mulic-Lutvica A, Gissler M, Bødker B, Bremme K, Ellingsen L, Vangen S. The impact of cardiovascular diseases on maternal deaths in the Nordic countries. Acta Obstet Gynecol Scand 2021; 100:1273-1279. [PMID: 33524162 DOI: 10.1111/aogs.14104] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cardiovascular diseases have become increasingly important as a cause of maternal death in the Nordic countries. This is likely to be associated with a rising incidence of pregnant women with congenital and acquired cardiac diseases. Through audits, we aim to prevent future maternal deaths by identifying causes of death and suboptimal factors in the clinical management. MATERIAL AND METHODS Maternal deaths in the Nordic countries from 2005 to 2017 were identified through linked registers. The national audit groups performed case assessments based on hospital records, classified the cause of death, and evaluated the standards of clinical care provided. Key messages were prepared to improve treatment. RESULTS We identified 227 maternal deaths, giving a maternal mortality rate of 5.98 deaths per 100 000 live births. The most common cause of death was cardiovascular disease (n = 36 deaths). Aortic dissection/rupture, myocardial disease, and ischemic heart disease were the most common diagnoses. In nearly 60% of the cases, the disease was not recognized before death. In more than half of the deaths, substandard care was identified (59%). In 11 deaths (31%), improvements to care that may have made a difference to the outcome were identified. CONCLUSIONS Between 2005 and 2017, cardiovascular diseases were the most common causes of maternal deaths in the Nordic countries. There appears to be a clear potential for a further reduction in these maternal deaths. Increased awareness of cardiac symptoms in pregnant women seems warranted.
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Affiliation(s)
- Lill T Nyfløt
- Norwegian Research center for Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics, Drammen Hospital, Drammen, Norway
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ajlana Mulic-Lutvica
- Institution for Women's and Children's Health, Department for Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Katarina Bremme
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Liv Ellingsen
- Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Siri Vangen
- Norwegian Research center for Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Skhvitaridze N, Anda EE, Brenn T, Kintraia N, Gamkrelidze A. Scoping maternal care through the lens of maternal deaths: A retrospective analysis of maternal mortality in Georgia. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100560. [PMID: 33059117 DOI: 10.1016/j.srhc.2020.100560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Reduction of the maternal mortality ratio (MMR) to 12 per 100,000 live births by 2030 is a priority target in Georgia. This study aims to assess and classify MM in Georgia by direct and indirect causes of death from 2014 to 2017, using data from the national surveillance system and in accordance with internationally approved criteria. MATERIAL AND METHODS In this secondary study, MM data was retrieved from the Maternal and Children's Health Coordinating Committee and validated with data from the Vital Registry System and the Georgian Birth Registry. The study sample comprised 61 eligible MM cases. Relevant information was transferred to case-report forms to review and classify MM cases by direct and indirect causes of maternal death. RESULTS The MMR during the study period was 26.7 per 100,000 live births. The proportion of direct causes of maternal death exceeded that of indirect causes, at 62% and 38%, respectively. The leading direct cause of maternal death was haemorrhage, while infection was the most frequent indirect cause. 52.5% of MM cases had no pre-existing medical condition, 62.3% had frequent adherence to antenatal care, and 52.5% had emergency caesarean sections. CONCLUSION In Georgia, direct causes of maternal death exceed indirect causes in MM cases, with haemorrhage and infections, respectively, being most common. These findings are important to ensure optimal and continuous care and to accelerate progress in the reduction of MM in the country.
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Affiliation(s)
- Natia Skhvitaridze
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway; National Center for Disease Control and Public Health, Kakheti Highway 99, Tbilisi 0198, Georgia; The University of Georgia, Kostava Street 77a, Tbilisi 0171, Georgia.
| | - Erik Eik Anda
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway
| | - Tormod Brenn
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 18, Tromsø 9037, Norway
| | - Nikoloz Kintraia
- Georgian Perinatal Association, Kostava Street 38, Tbilisi 0179, Georgia
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health, Kakheti Highway 99, Tbilisi 0198, Georgia
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Bergman L, Sandström A, Jacobsson B, Hansson S, Lindgren P, Larsson A, Imberg H, Conner P, Kublickas M, Carlsson Y, Wikström AK. Study for Improving Maternal Pregnancy And Child ouTcomes (IMPACT): a study protocol for a Swedish prospective multicentre cohort study. BMJ Open 2020; 10:e033851. [PMID: 32967865 PMCID: PMC7513602 DOI: 10.1136/bmjopen-2019-033851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION First-trimester pregnancy risk evaluation facilitates individualised antenatal care, as well as application of preventive strategies for pre-eclampsia or birth of a small for gestational age infant. A range of early intervention strategies in pregnancies identified as high risk at the end of the first trimester has been shown to decrease the risk of preterm pre-eclampsia (<37 gestational weeks). The aim of this project is to create the Improving Maternal Pregnancy And Child ouTcomes (IMPACT) database; a nationwide database with individual patient data, including predictors recorded at the end of the first trimester and later pregnancy outcomes, to identify women at high risk of pre-eclampsia. A second aim is to link the IMPACT database to a biobank with first-trimester blood samples. METHODS AND ANALYSIS This is a Swedish prospective multicentre cohort study. Women are included between the 11th and 14th weeks of pregnancy. At inclusion, pre-identified predictors are retrieved by interviews and medical examinations. Blood samples are collected and stored in a biobank. Additional predictors and pregnancy outcomes are retrieved from the Swedish Pregnancy Register. Inclusion in the study began in November 2018 with a targeted sample size of 45 000 pregnancies by end of 2021. Creation of a new risk prediction model will then be developed, validated and implemented. The database and biobank will enable future research on prediction of various pregnancy-related complications. ETHICS AND DISSEMINATION Confidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (Uppsala 2018-231) and national biobank approval at Uppsala Biobank (18237 2 2018 231). Results from the current as well as future studies using information from the IMPACT database will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03831490.
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Affiliation(s)
- Lina Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Obstetrics and Gynecology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Anna Sandström
- Department of Women's and Children's Health, Uppsala University Disciplinary Domain of Medicine and Pharmacy, Uppsala, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Stefan Hansson
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Lunds Universitet, Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Peter Lindgren
- Center for Fetal Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Henrik Imberg
- Department of Mathematical Sciences, Chalmers University of Technology, Goteborg, Sweden
| | - Peter Conner
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Marius Kublickas
- Center for Fetal Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | - Ylva Carlsson
- Department of Obstetrics and Gynecology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University Disciplinary Domain of Medicine and Pharmacy, Uppsala, Sweden
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Jayakody H, Knight M. Implementation assessment in confidential enquiry programmes: A scoping review. Paediatr Perinat Epidemiol 2020; 34:399-407. [PMID: 31846103 PMCID: PMC7383863 DOI: 10.1111/ppe.12604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/08/2019] [Accepted: 09/17/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Response should be a key part of maternal death surveillance and response (MDSR) programmes, which include confidential enquiries into maternal deaths. The programmes investigate avoidable factors in maternal deaths and make recommendations for improving maternity care. There is a gap in information on how these recommendations are transformed into practice. OBJECTIVE To explore the methods used to assess the implementation status of recommendations made in confidential enquiries into maternal deaths and other health outcomes. DATA SOURCES We searched PubMed, Web of Science, CINAHL, and Google Scholar databases and general web for grey literature using the "Arksey and O'Malley framework" in all major scientific databases and search engines. STUDY SELECTION AND DATA EXTRACTION An initial screening was followed by extraction of information using a data chart. Variables in the chart were based on the response component of maternal death and surveillance systems. SYNTHESIS Information collected was summarised using content analysis method. RESULTS We reviewed 13 confidential enquiry systems into maternal deaths. Many confidential enquiries into maternal deaths published reports with their recommendations and dissemination often involved national-level scientific presentations. Only five reports provided strategies for implementing the recommendations. Follow-up of previous recommendations was routinely published in only two reports. However, impact assessment of recommendations on other health outcomes was found only in the UK. CONCLUSION There is a gap in monitoring the response generated by confidential enquiries into maternal deaths. Actions to develop this are therefore needed.
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Affiliation(s)
- Hemali Jayakody
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
| | - Marian Knight
- National Perinatal Epidemiology UnitUniversity of OxfordOxfordUK
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35
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Berdzuli N, Lomia N, Staff AC, Kereselidze M, Lazdane G, Jacobsen AF. Maternal Mortality in Georgia: Incidence, Causes and Level of Underreporting: A National Reproductive Age Mortality Study 2014. Int J Womens Health 2020; 12:277-286. [PMID: 32308502 PMCID: PMC7154943 DOI: 10.2147/ijwh.s227349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Accurate data on maternal mortality are essential for assessing progress towards Sustainable Development Goals (SDG).The aim of the study was to determine the incidence and causes of maternal deaths in Georgia, then explore the potential for improvement of quality of maternal health care. The study’s secondary aims were to identify the level of underreporting of maternal deaths in Georgian vital statistics over 1 year (2012) and to compare these results with previous data from 2006. The study findings allow to support the country in developing evidence-based policies and tracking progress towards meeting SDG targets. Methods A national Reproductive Age Mortality Survey (RAMOS) was conducted in Georgia in 2014–15. Multiple data sources were used to identify deaths of women aged 15–49 years between January and December 2012. All deaths in women of reproductive age were investigated through verbal autopsy (VA) diagnoses. Deaths in women during pregnancy or one-year postpartum were further investigated by conducting interviews and medical record reviews at the last medical facility which provided health care for the woman during her fatal condition. A specialist panel reviewed these cases and assigned underlining causes of deaths. Results We found that 98% of deaths among women of reproductive age were registered by Georgia's civil registration and vital statistics system (CRVS). A total of 918 deaths met the study inclusion criteria. Thirty-six (4.1%) women died during pregnancy or within one-year postpartum. Among these 36 deaths, 23 (63.8%) were maternal deaths, 15 early (either during pregnancy or 42 days postpartum) and eight late (43–365 days postpartum) deaths (65.2% vs 34.8%). The remaining 13 of 36 deaths were coincidental deaths. Fourteen maternal deaths were reported by official statistics and nine deaths were not included in these statistics. Thus, the underreporting rate was 39%. Direct obstetric causes accounted for 73.9% (n=17) of maternal deaths, whereas 26.1% (n=6) were indirect. The leading causes of direct maternal deaths were infection (21.7%), hemorrhage (17.4%), pulmonary embolism (13.0%), and pregnancy-induced hypertension (8.7%). The RAMOS study calculated a maternal mortality ratio (early maternal deaths) of 26.3 per 100,000 live births compared with the official figure of 22.8 per 100,000 live births. Discussions Registration of early maternal deaths significantly improved since last survey in 2008, while indirect and late maternal deaths continue to be unrecognized, as reflected in official Georgian statistics. The difference between RAMOS study findings and officially reported maternal mortality rates is minimal, showing improvements in detection of maternal deaths by the national maternal mortality surveillance system. The greatest number of direct obstetric deaths occur in the first week postpartum, which likely reflects deficiencies in quality of care.
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Affiliation(s)
- Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Diseases Control and Public Health, Tbilisi, Georgia
| | | | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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García-Tizón Larroca S, Amor Valera F, Ayuso Herrera E, Cueto Hernandez I, Cuñarro Lopez Y, De Leon-Luis J. Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature. BMC Pregnancy Childbirth 2020; 20:224. [PMID: 32299375 PMCID: PMC7164222 DOI: 10.1186/s12884-020-02901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage. Trial registration PROSPERO ID: CRD 42019133464
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Affiliation(s)
- Santiago García-Tizón Larroca
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.
| | - Francisco Amor Valera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Esther Ayuso Herrera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Ignacio Cueto Hernandez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Yolanda Cuñarro Lopez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Juan De Leon-Luis
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.,Department of Public and Maternal-Infant Health, Complutense University, Madrid, Spain
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Lega I, Maraschini A, D'Aloja P, Andreozzi S, Spettoli D, Giangreco M, Vichi M, Loghi M, Donati S. Maternal suicide in Italy. Arch Womens Ment Health 2020; 23:199-206. [PMID: 31104119 DOI: 10.1007/s00737-019-00977-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/03/2019] [Indexed: 01/01/2023]
Abstract
Suicide has been identified as one of the most common causes of death among women within 1 year after the end of pregnancy in several high-income countries. The aim of this study was to provide the first estimate of the maternal suicide ratio and a description of the characteristics of women who died by suicide during pregnancy or within 1 year after giving birth, induced abortion or miscarriage (i.e., maternal suicide) in 10 Italian regions, covering 77% of total national births. Maternal suicides were identified through the linkage between regional death registries and hospital discharge databases. Background population data was collected from the national hospital discharge, abortion and mortality databases. The previous psychiatric history of the women who died by maternal suicide was retrieved from the regionally available data sources. A total of 67 cases of maternal suicide were identified, corresponding to a maternal suicide ratio of 2.30 per 100,000 live births in 2006-2012. The suicide rate was 1.18 per 100,000 after giving birth (n = 2,876,193), 2.77 after an induced abortion (n = 650,549) and 2.90 after a miscarriage (n = 379,583). The majority of the women who died by maternal suicide (34/57) had a previous psychiatric history; 15/18 previously diagnosed mental disorders were not registered along with the index pregnancy obstetric records. Suicide is a relevant cause of maternal death in Italy. The continuity of care between primary, mental health and maternity care were found to be critical. Clinicians should be aware of the issue, as they may play an important role in preventing suicide in their patients.
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Affiliation(s)
- Ilaria Lega
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Paola D'Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Silvia Andreozzi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Daniela Spettoli
- SaPeRiDoC -Documentation Centre on Perinatal and Reproductive Health, Primary Care Service, Regional Health Authority of Emilia-Romagna, Bologna, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Monica Vichi
- Service of Statistics, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Marzia Loghi
- Integrated System for Health, Social Assistance, Welfare and Justice - Directorate for Social Statistics and Population Census - ISTAT, Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
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Heemelaar S, Petrus A, Knight M, van den Akker T. Maternal mortality due to cardiac disease in low- and middle-income countries. Trop Med Int Health 2020; 25:673-686. [PMID: 32133737 PMCID: PMC7318167 DOI: 10.1111/tmi.13386] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To assess the frequency of maternal death (MD) due to cardiac disease in low‐ and middle‐income countries (LMIC). Methods Systematic review searching Medline, EMBASE, Web of Science, Cochrane Library, Emcare, LILACS, African Index Medicus, IMEMR, IndMED, WPRIM, IMSEAR up to 01/Nov/2017. Maternal mortality reports from LMIC reviewing all MD in a given geographical area were included. Hospital‐based reports or those solely based on verbal autopsies were excluded. Numbers of MD and cardiac‐related deaths were extracted. We calculated cardiac disease MMR (cMMR, cardiac‐related MD/100 000 live births) and proportion of cardiac‐related MDs among all MDs. Frequency of cardiac MD was compared with the MMR of the country. Results Forty‐seven reports were included, which reported on 38,486 maternal deaths in LMIC. Reported cMMR ranged from 0/100 000 live births (Moldova, Ghana) to 31.9/100 000 (Zimbabwe). The proportion of cardiac‐related MD ranged from 0% (Moldova, Ghana) to 24.8% (Sri Lanka). In countries with a higher MMR, cMMR was also higher. However, the proportion of cardiac‐related MD was higher in countries with a lower MMR. Conclusions The burden of cardiac‐related mortality is difficult to assess due limited availability of mortality reports. The proportion of cardiac deaths among all MD appeared to be higher in countries with a lower MMR. This is in line with what has been called ‘obstetric transition’: pre‐existing medical diseases including cardiac disease are becoming relatively more important where the MMR falls.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Obstetrics and Gynaecology, Katutura State Hospital, Windhoek, Namibia
| | - Annelieke Petrus
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.,National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Athena Institute, VU University, Amsterdam, The Netherlands
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Petrus AHJ, Jongert BL, Kiès P, Sueters M, Jongbloed MRM, Vliegen HW, Schalij MJ, van Lith J, van den Akker T. Evaluation of mode of birth in pregnant women with heart disease. Eur J Obstet Gynecol Reprod Biol 2020; 248:150-155. [PMID: 32244032 DOI: 10.1016/j.ejogrb.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Maternal heart disease (HD) complicates 1-4 % of pregnancies and is associated with adverse maternal and fetal outcomes. Although vaginal birth is generally recommended in the guidelines, cesarean section (CS) rates in women with HD are often high. Aim of the present study was to evaluate mode of birth and pregnancy outcomes in women with HD in a tertiary care hospital in the Netherlands. STUDY DESIGN The study population consisted of 128 consecutive pregnancies in 99 women with HD, managed by a pregnancy heart team between 2012-2017 and ending in births after 24 weeks' gestation. Pregnancy risk was assessed per modified World Health Organization class. Mode of birth (planned and performed) and maternal and fetal complications (cardiovascular events, postpartum hemorrhage, prematurity, small for gestational age and death) were assessed for each pregnancy. RESULTS Pregnancy risk was classified as modified World Health Organization class I in 23 %, class II in 50 %, class III in 21 % and class IV in 6% of pregnancies. Planned mode of birth was vaginal in 114 pregnancies (89 %) and CS in 14 (11 %; nine for obstetric and five for cardiac indication). An unplanned CS was performed in 18 pregnancies (16 %; 16 for obstetric and two for cardiac indications). Overall mode of birth was vaginal in 75 % and CS in 25 %. Twelve cardiovascular events occurred in eight pregnancies (6 %), postpartum hemorrhage in nine (7 %) and small for gestational age in 14 (11 %). No maternal or fetal deaths occurred. CONCLUSIONS Findings of this study indicate that - given that pregnancies are managed and mode of birth is meticulously planned by a multidisciplinary pregnancy heart team - vaginal birth is a suitable option for women with HD.
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Affiliation(s)
| | - Britt L Jongert
- Department of Obstetrics, Leiden University Medical Centre, the Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Centre, the Netherlands
| | - Marieke Sueters
- Department of Obstetrics, Leiden University Medical Centre, the Netherlands
| | | | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Centre, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Centre, the Netherlands
| | - Jan van Lith
- Department of Obstetrics, Leiden University Medical Centre, the Netherlands
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40
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Nadeev AP, Karpovich GS. [Extragenital diseases, comorbidities, and polymorbidity in maternal death]. Arkh Patol 2019; 81:11-16. [PMID: 31407712 DOI: 10.17116/patol20198104111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the structure and significance of comorbidities and polymorbidity in maternal death. MATERIAL AND METHODS Sixty-five autopsy protocols of maternal deaths in the Novosibirsk Region in the period of 1994 to 2018 were analyzed. RESULTS Extragenital diseases are the leading diseases in the nosological structure in maternal mortality. Preeclampsia/exlampsia and obstetric hemorrhages lost their leading positions. The increasing role of extragenital pathology in the structure of maternal mortality is due to many factors, such as a larger number of comorbidities and polymorbidity, in pregnant women. Infectious diseases, benign and malignant tumors, and diseases of the heart and blood vessels are the main diseases in the structure of extragenital diseases.
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Affiliation(s)
- A P Nadeev
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
| | - G S Karpovich
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
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Engin-Üstün Y, Sanisoğlu S, Keskin HL, Karaahmetoğlu S, Özcan A, Çelen Ş, Üstün Y, Alkan A, Ongun V, Şencan İ. Changing trends in the Turkish maternal deaths, with a focus on direct and indirect causes. Eur J Obstet Gynecol Reprod Biol 2019; 234:21-25. [PMID: 30640122 DOI: 10.1016/j.ejogrb.2018.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our aim is to evaluate trends in the direct and indirect causes' distribution using data from National Maternal Mortality Surveillance (2012-2015). STUDY DESIGN A population-based retrospective review was performed on all pregnancy-associated maternal deaths in Turkey from 2012 to 2015. Causes of death were grouped into direct and indirect maternal deaths and compared in the context of distribution. Maternal mortality rate was reported. Statistics included chi-square test or Fisher's exact test for categorical variables. RESULTS Between 2012 and 2015 there were 812 maternal deaths. The maternal mortality rate was 15.4 deaths per 100,000 live births in 2012 as compared to 13.7 in 2015. Direct maternal deaths in Turkey declined from 59.5% in 2012 to 45% in 2015 while indirect maternal deaths increased from 45% in 2012 to 55% in 2015 (p = 0.045). The leading direct causes of maternal deaths were postpartum hemorrhage. The major indirect causes of maternal deaths were circulatory system diseases. CONCLUSION Direct maternal deaths in Turkey appear to be declining. This data will aid the management of maternal deaths.
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Affiliation(s)
- Yaprak Engin-Üstün
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Sema Sanisoğlu
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Hüseyin Levent Keskin
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey.
| | - Selma Karaahmetoğlu
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Ayşe Özcan
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Şevki Çelen
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Yusuf Üstün
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Afra Alkan
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Veli Ongun
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - İrfan Şencan
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
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Blagoeva Atanasova V, Arevalo-Serrano J, Antolin Alvarado E, García-Tizón Larroca S. Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999-2015. BMC Public Health 2018; 18:1171. [PMID: 30314490 PMCID: PMC6186083 DOI: 10.1186/s12889-018-6091-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background The available literature suggests that there are significant differences in maternal mortality according to maternal origin in high income countries. The objective of this study was to quantify the risk of maternal death by maternal origin and region of Spain where the birth occurred and to identify the most important causes of maternal death in our country. Methods An ecological cross-sectional study was conducted that included all deliveries that resulted in maternal survival and cases of maternal death during 1999–2015 in Spain. A descriptive analysis of the maternal mortality rate by maternal origin, region and year of birth was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analysis, with adjustment for the variables included in the descriptive analysis. Results There were 272 maternal deaths during this period, most of which were due to haemorrhage (63 cases, 23.16%).Women whose continent of origin was South America had the highest adjusted risk of maternal death, with an OR of 3.92 (95% CI 2.75–5.58). The region of Spain with the highest risk of maternal death was Ceuta, with an OR of 12.11 (95% CI 2.02–72.68). Conclusions This study shows that there are inequalities in maternal mortality according to maternal origin and region where labour occurred. These findings highlight the need to establish strategies at the national and European levels to analyse the most relevant causes and risk factors associated with maternal mortality in order to reduce it and pay closer attention in identifying and carefully managing pregnant women from this at risk groups.
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Affiliation(s)
- V Blagoeva Atanasova
- Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - J Arevalo-Serrano
- Department of Internal Medicine, Hospital Universitario, Principe de Asturias de Alcalá de Henares, Madrid, Spain
| | | | - Santiago García-Tizón Larroca
- Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. .,Obstetrics and Gynecology Unit, Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28029, Madrid, ES, Spain.
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Johansen LT, Braut GS, Andresen JF, Øian P. An evaluation by the Norwegian Health Care Supervision Authorities of events involving death or injuries in maternity care. Acta Obstet Gynecol Scand 2018; 97:1206-1211. [PMID: 29806955 PMCID: PMC6175322 DOI: 10.1111/aogs.13391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/13/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We aimed to determine how serious adverse events in obstetrics were assessed by supervision authorities. MATERIAL AND METHODS We selected cases investigated by supervision authorities during 2009-2013. We analyzed information about who reported the event, the outcomes of the mother and infant, and whether events resulted from errors at the individual or system level. We also assessed whether the injuries could have been avoided. RESULTS During the study period, there were 303 034 births in Norway, and supervision authorities investigated 338 adverse events in obstetric care. Of these, we studied 207 cases that involved a serious outcome for mother or infant. Five mothers (2.4%) and 88 infants (42.5%) died. Of the 207 events reported to the supervision authorities, patients or relatives reported 65.2%, hospitals reported 39.1%, and others reported 4.3%. In 8.7% of cases, events were reported by more than 1 source. The supervision authority assessments showed that 48.3% of the reported cases involved serious errors in the provision of health care, and a system error was the most common cause. We found that supervision authorities investigated significantly more events in small and medium-sized maternity units than in large units. Eighteen health personnel received reactions; 15 were given a warning, and 3 had their authority limited. We determined that 45.9% of the events were avoidable. CONCLUSIONS The supervision authorities investigated 1 in 1000 births, mainly in response to complaints issued from patients or relatives. System errors were the most common cause of deficiencies in maternity care.
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Affiliation(s)
| | - Geir Sverre Braut
- Stavanger University Hospital and Western Norway University of Applied SciencesStavangerNorway
| | | | - Pål Øian
- Department of Obstetrics and GynecologyFaculty of Health SciencesInstitute of Clinical MedicineThe University Hospital of North NorwayThe Arctic University of NorwayTromsøNorway
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Donati S, Maraschini A, Lega I, D'Aloja P, Buoncristiano M, Manno V. Maternal mortality in Italy: Results and perspectives of record-linkage analysis. Acta Obstet Gynecol Scand 2018; 97:1317-1324. [DOI: 10.1111/aogs.13415] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/21/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Serena Donati
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | - Alice Maraschini
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | - Paola D'Aloja
- National Center for Disease Prevention and Health Promotion; Rome Italy
| | | | - Valerio Manno
- Statistics Service; Italian National Institute of Health-Istituto Superiore di Sanità; Rome Italy
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O'Shaughnessy F, Donnelly JC, Cooley SM, Deering M, Raman A, Gannon G, Hickey J, Holland A, Hayes N, Bennett K, Ní Áinle F, Cleary BJ. Thrombocalc: implementation and uptake of personalized postpartum venous thromboembolism risk assessment in a high-throughput obstetric environment. Acta Obstet Gynecol Scand 2017; 96:1382-1390. [PMID: 28832906 DOI: 10.1111/aogs.13206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/06/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Venous thromboembolism risk assessment (VTERA) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user-friendly electronic VTERA tool. MATERIAL AND METHODS We developed "Thrombocalc", an electronic VTERA tool using Microsoft EXCEL™ . Thrombocalc was designed as a score-based tool to facilitate rapid assessment of all women after childbirth. Calculation of a total score estimated risk of venous thromboembolism in line with consensus guidelines. Recommendations for thromboprophylaxis were included in the VTERA output. Implementation was phased. Uptake of the VTERA tool was assessed prospectively by monitoring the proportion of women who gave birth in our institution and had a completed risk assessment. Factors affecting completion and accuracy of risk assessments were also assessed. RESULTS Thrombocalc was used prospectively to risk-assess 8380 women between September 2014 and December 2015. Compliance with this tool increased dramatically throughout the study period; over 92% of women were risk-assessed in the last quarter of data collection. Compliance was not adversely affected if delivery took place out of working hours [adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 0.93-1.14]. Risk assessment was less likely in the case of cesarean deliveries (aOR 0.66, 95% CI 0.60-0.73) and stillborn infants (aOR 0.48, 95% CI 0.29-0.79). Misclassification of risk factors led to approximately 207 (2.5%) inaccurate thromboprophylaxis recommendations. CONCLUSIONS Our electronic, score-based VTERA tool provides a highly effective mechanism for rapid assessment of individual postpartum venous thromboembolism risk in a high-throughput environment.
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Affiliation(s)
- Fergal O'Shaughnessy
- Pharmacy Department, Rotunda Hospital, Dublin, Ireland.,Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer C Donnelly
- Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland.,Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sharon M Cooley
- Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland
| | - Mary Deering
- Department of Midwifery, Rotunda Hospital, Dublin, Ireland
| | - Ajita Raman
- Department of Midwifery, Rotunda Hospital, Dublin, Ireland
| | | | - Jane Hickey
- Department of Midwifery, Rotunda Hospital, Dublin, Ireland
| | - Alan Holland
- Department of Finance, Rotunda Hospital, Dublin, Ireland
| | - Niamh Hayes
- Department of Anesthesia, Rotunda Hospital, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fionnuala Ní Áinle
- Department of Hamatology, Rotunda Hospital, Dublin, Ireland.,School of Medicine and SPHERE Research Group, University College Dublin, Conway Institute, Dublin, Ireland.,Department of Hematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Brian J Cleary
- Pharmacy Department, Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
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