Background: The U.S. is currently one of thirteen countries where maternal mortality rates (MMR) is worse now than it was fifteen years ago. Reducing maternal mortality is one of the significant challenges facing the health system in the United States, especially in the State of Georgia, which has one of the highest MMR in the nation. The purpose of this review is to explore the causes, policy, and ethical contextual factors contributing to increased maternal mortality rates among African American women in the State of Georgia. Also, identifying and addressing weaknesses and gaps that exist in the healthcare system and recommending policy implications to seek to reduce the MMR. Methods: This study conducted a comprehensive literature review from the online database and also used data from CDC Wonder, OASIS Georgia, and Georgia Department of Public Health website to identify the primary antecedents of elevated MMR among African American women in the State of Georgia with specific attention to policy and ethical considerations. Results: This review found factors that were related to causes of maternal death in the U.S. include socioeconomic status, communication between patient and healthcare provider, and maternal medical conditions and complications during pregnancy. In the State of Georgia, complications during pregnancy and cardiomyopathy were the leading cause of MMR, particularly among African American women in comparison with other races. However, inconsistency in reporting maternal death data was another issue that is discussed in this review. Conclusions: Policies that incorporate ethical considerations need to be developed to benefit the family and society. Policymakers should seek to develop targeted policies in support of specific vulnerable populations through improving maternal screening, health promotion, behavior uptake, and effective case management.
Objective To assess the “July effect” and the risk of postpartum hemorrhage (PPH) and its risk factors across the U.S. teaching hospitals. Method This study used the 2018 Nationwide Inpatient Sample (NIS) and included 2,056,359 of 2,879,924 single live-birth hospitalizations with low-risk pregnancies across the U.S. teaching hospitals. The International Classification of Diseases, Tenth Revision (ICD-10) from the American Academy of Professional Coders (AAPC) medical coding was used to identify PPH and other study variables. Multivariable logistic regression models were used to compare the adjusted odds of PPH risk in the first and second quarters of the academic year vs. the second half of the academic year. Results Postpartum hemorrhage occurred in approximately 4.19% of the sample. We observed an increase in the adjusted odds of PPH during July through September (adjusted odds ratios (AOR), 1.05; confidence interval (CI), 1.02–1.10) and October through December (AOR, 1.07; CI, 1.04–1.12) compared to the second half of the academic year (January to June). Conclusions This study showed a significant “July effect” concerning PPH. However, given the mixed results concerning maternal outcomes at the time of childbirth other than PPH, more research is needed to investigate the “July effect” on the outcomes of the third stage of labor. This study’s findings have important implications for patient safety interventions concerning MCH.
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