Maternal deaths in an urban perinatal network, 1992-1998

Panting-Kemp, Andrea; Geller, Stacie E.; Nguyen, Tuan M.; Simonson, Louise; Nuwayhid, B.; Castro, Lony C.

doi:10.1067/mob.2000.108846

Cited by 62 publications

(29 citation statements)

References 8 publications

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“…Several reports have shown that vital statistics data alone under-report maternal deaths as much as 30 to 60% compared to enhanced surveillance. [18][19][20][21] Furthermore, our institution is a regional perinatal center, which accepts referral of women at high risk of morbidity and death.…”

Section: Discussionmentioning

confidence: 99%

Predictors of maternal mortality and near-miss maternal morbidity

et al. 2007

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Objective: To identify risk factors for life-threatening maternal outcomes.Study Design: Hospital charts were reviewed for cases of maternal mortality or near-miss and for controls overmatched 1:3. Significant risk factors were identified through simple and best subsets multiple logistic regression.Result: Eight cases of mortality and 69 near-miss cases were found. Significant risk factors with their odds ratios and 95% confidence intervals are: age 35 to 39 years (2.3, 1.2 to 4.4) and >39 years (5.1, 1.8 to 14.4); African-American race (7.4, 2.5 to 22.0) and Hispanic ethnicity (4.2, 1.3 to 13.2); chronic medical condition (2.7, 1.5 to 4.8); obesity (3.0, 1.7 to 5.3); prior cesarean (5.2, 2.8 to 9.8) and gravidity (1.2, 1.1 to 1.5 per pregnancy). In multivariable logistic regression, race remained significant while controlling for other significant factors and markers of socioeconomic status.Conclusion: Some risk factors can be modified through medical care, education or social support systems. Racial disparity in outcome is confirmed and is unexplained by traditional risk factors.

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Section: Discussionmentioning

confidence: 99%

Predictors of maternal mortality and near-miss maternal morbidity

et al. 2007

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“…This included 46% of injury deaths and 16% of deaths from medical causes. Panting-Kemp et al 7 found similar results in Chicago between 1992 and 1999, where 36% of all maternal deaths were preventable: 37% of pregnancy-related deaths and 30% of unrelated deaths.…”

Section: Introductionmentioning

confidence: 74%

“…This need is all the more apparent considering that investigations show that the maternal mortality rate is underestimated, that certain groups are disproportionately affected, and that many of the deaths may be preventable. 1,[6][7][8] Preventability of maternal death and illness can refer to primary prevention of the cause of death, such as prevention of ectopic pregnancy through screening and treatment for sexually transmitted diseases. Alternatively, preventability can refer to institutional, provider, and patient factors that may have ultimately prevented a condition from causing death or severe morbidity, such as timely diagnosis and treatment of severe pre-eclampsia.…”

Section: Introductionmentioning

confidence: 99%

A descriptive model of preventability in maternal morbidity and mortality

2006

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Objective: To develop a descriptive model of preventability for maternal morbidity and mortality that can be used in quality assurance and morbidity and mortality review processes.Study Design: This descriptive study was part of a larger case-control study conducted at the University of Illinois at Chicago in which maternal deaths were cases and women with severe maternal morbidity served as controls. Morbidities and mortalities were classified by a team of clinicians as preventable or not preventable. Qualitative analysis of data was conducted to identify and categorize different types of preventable events.Results: Of 237 women, there were 79 women with preventable events attributable to provider or system factors. The most common types of preventable events were inadequate diagnosis/recognition of high-risk (54.4%), treatment (38.0%), and documentation (30.7%).Conclusions: A descriptive model was illustrated that can be used to categorize preventable events in maternal morbidity and mortality and can be incorporated into quality assurance and clinical case review to enhance the monitoring of hospital-based obstetric care and to decrease medical error.

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“…5 Over a third of maternal deaths and severe morbidities, and a significant proportion of neonatal mortality and morbidity may be preventable by changes in patient, clinician, and system factors. 4,[6][7][8][9] As part of its core measure set, the Joint Commission now recommends two perinatal quality measures that address important aspects of obstetric care during childbirth: 1) elective deliveries performed prior to 39 weeks of gestation and 2) cesarean deliveries performed in low-risk nulliparous women. 10 The elective delivery measure, which includes non-medically indicated deliveries associated with medical induction or cesarean delivery over 37 weeks and prior to 39 weeks gestation, is also mandated by the Centers for Medicare and Medicaid Services.…”

Section: Conclusion and Relevance-rates For The Quality Indicators Ementioning

confidence: 99%

Association Between Hospital-level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

Howell

Zeitlin

Hebert

et al. 2015

Obstetric Anesthesia Digest

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Importance-In an effort to improve the quality of care, several obstetric-specific quality measures are now monitored and publically reported. The extent to which these measures are associated with maternal and neonatal morbidity is not known.Objective-To examine whether 2 Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity.Design, Setting, and Participants-Population-based observational study using linked 2010 New York City discharge and birth certificate datasets. All delivery hospitalizations were identified and two perinatal quality measures were calculated. Published algorithms were used to identify severe maternal morbidity (delivery associated with a life threatening complication or performance of a life-saving procedure) and morbidity in non-anomalous term newborns (births The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Author Contributions: Dr. Egorova had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.• Study concept and design: Howell, Zeitlin, Hebert, Balbierz, and Egorova associated with complications such as birth trauma, hypoxia, and prolonged length of stay). Mixed-effects logistic regression models were used to examine the association between maternal morbidity, neonatal morbidity, and hospital-level quality measures while risk-adjusting for patient sociodemographic and clinical characteristics. Exposure-TwoJoint Commission perinatal quality measures: 1) elective (non-medically indicated) deliveries at >= 37 and < 39 weeks of gestation and 2) cesarean delivery performed in low-risk mothers.Main Outcomes and Measures-Individual and hospital level maternal and neonatal morbidity. Although great progress has been made in reducing obstetric complications, they persist. Severe maternal complications include renal failure and eclampsia or the need for lifesaving interventions such as prolonged mechanical ventilation or transfusions. 1,2 Neonatal complications may occur in low-risk term infants and include hypoxia and shock. 3 Severe maternal morbidity occurs in about 60,000 women (1.6 per 100 deliveries) annually in the US and 1 in 10 term infants experience neonatal complications. 3,4 Variation in complication rates between hospitals exists and suggests that the quality of obstetric care can be improved. 5 Over a third of maternal deaths and severe morbidities, and a significant proportion of neonatal mortality and morbidity may be preventable by changes in patient, clinician, and system factors. 4,[6][7][8][9] As part of its core measure set, the Joint Commission now recommends two perinatal quality measures that address important aspects of obstetric care during childbirth: 1) elective deliveries performed prior to 39 weeks of gestation and 2) cesarean deliveries performed in low-risk nulliparous women. 10 The elective delivery measure, which includes non-medi...

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Maternal deaths in an urban perinatal network, 1992-1998

Cited by 62 publications

References 8 publications

Predictors of maternal mortality and near-miss maternal morbidity

Predictors of maternal mortality and near-miss maternal morbidity

A descriptive model of preventability in maternal morbidity and mortality

Association Between Hospital-level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

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