Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues

Studnicki, James; Fisher, John W.

doi:10.1097/aog.0000000000002603

Cited by 2 publications

(2 citation statements)

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“…Opioid side effects, such as sedation, nausea and vomiting, delay postoperative mobilization and thus increase risks of postpartum thromboembolic complications. These remain one of the most important causes of maternal mortality in developed countries, including Slovenia [3,[24][25][26]. Moreover, reducing the in-hospital opioids after CD helps preventing persistent opioid use after hospital discharge [9].…”

Section: Discussionmentioning

confidence: 99%

Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery

2021

Clinical and Experimental Obstetrics & Gynecology

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Background: Opioid over-prescription after cesarean delivery (CD) delays postoperative recovery, interferes with breastfeeding and may prompt persistent opioid use after hospital discharge. We evaluated the effects of implementing a multimodal stepwise analgesic regimen on opioid consumption and pain scores after CD. Methods: This was a retrospective before-after study. Opioid intake (expressed as morphine milligram equivalents (MME)) and pain scores (using the 11-point numerical rating score) within 24-hours following planned cesarean delivery under spinal anesthesia without intrathecal morphine were compared before vs. after change in postcesarean analgesia regimen. This included intensified non-opioid analgesia with quadratus lumborum block and shifting from scheduled to as-needed opioids. Mann-Whitney U test was used for statistical comparison (p < 0.05 was considered statistically significant). Results: We included 116 women: 58 in pre-intervention and 58 in post-intervention group. There was an 86% reduction in MME (median 14 (interquarile range (IQR) 14-18) mg pre-intervention vs. 2 (IQR 2-4) mg post-intervention; p < 0.001). Pain scores were statistically higher at 2 and 4 hours post-CD in the post-intervention group (1 (IQR 1-2) vs. 2 (IQR 1-3); p = 0.001, and 2 (IQR 1-3) vs. 2 (IQR 2-3); p = 0.03, respectively) but lower at 6 hours post-CD (3 (IQR 2-4) vs. 2 (IQR 2-3); p = 0.02). No statistically significant difference in pain scores at 1, 12 and 24 hours post-CD were observed. Conclusion: Multimodal stepwise analgesic regimen allowed shifting from scheduled to asneeded opioids for post-CD pain management without increase in pain scores. This resulted in significant reduction in opioid consumption after CD.

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Section: Discussionmentioning

confidence: 99%

Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery

2021

Clinical and Experimental Obstetrics & Gynecology

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“…Maternal deaths have been increasing in the US and recent population-based data shows that the peak incidence of self-harm related death (specifically overdose and suicide) is 9-12 months postpartum (128)(129)(130)(131). In contrast to a global trend in reduction of pregnant-and postpartum-related deaths, a large observational study reported a 26% increase in maternal deaths in 48 US states from 2000 to 2014 (131).…”

Section: Postpartummentioning

confidence: 99%

Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective

Barber

Terplan

2023

Front. Pediatr.

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Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.

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Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues

Cited by 2 publications

References 1 publication

Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery

Multimodal stepwise analgesia for reducing opioid consumption after cesarean delivery

Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective

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