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Maternal deaths following cesarean delivery can be reduced
August 04, 2008Maternal death rates have remained constant in the United States for many decades. Are there any improvements in health care that could reduce these rates further? In a study published in the July 2008 issue of the American Journal of Obstetrics & Gynecology, researchers examined all maternal deaths in nearly 1.5 million birth records from the last 6 years to look for possible keys to saving more mothers. The study demonstrated that the risk of death attributable to cesarean delivery, approximately 2/100,000 procedures, can realistically be reduced only with universal thromboembolism prophylaxis for patients delivered by cesarean.
The study identified 95 maternal deaths among 1,461,270 births (6.5/100,000 births). Leading causes of death were complications of preeclampsia, amniotic fluid embolism, obstetric hemorrhage, cardiac disease, and pulmonary thromboembolism.
The risk of death causally related to cesarean delivery is approximately 2/100,000 cesareans vs 0.2/100,000 deaths caused by vaginal birth. This statistically significant difference (P<.001) translates into approximately 20 US deaths caused by cesarean delivery annually.
Nine patients died from pulmonary thromboembolism, 7 after cesarean delivery and 2 after vaginal birth. None had received peripartum thromboembolism prophylaxis in the form of either fractionated or unfractionated heparin or pneumatic compression devices.
Writing in the article, Steven L. Clark, MD, Medical Director of the Women and Newborns Clinical Program, Hospital Corporation of America, states, "In nearly every population of adult surgical patients, either medical or mechanical thromboprophylaxis reduces venous thromboembolism by approximately 70%...If one assumes similar efficacy in pregnant women, 5 of the 7 deaths from pulmonary embolism in women undergoing cesarean delivery would have been prevented if a policy of universal use of medical or mechanical thromboprophylaxis for patients undergoing cesarean had been in place. Such a policy would reduce the mortality rate attributed causally to cesarean delivery to 0.9/100,000, or approximately 9 US deaths annually, eliminating the statistical difference in deaths attributed to cesarean vs. vaginal birth." Dr. Clark notes that the Hospital Corporation of American has instituted such a policy to improved patient safety throughout their system, the largest in the United States.
Dr. Clark continues, "It seems clear that the majority of maternal deaths in the United States are not preventable. The most common preventable errors in preeclampsia management leading to maternal death involved inattention to blood pressure control and signs or symptoms of pulmonary edema; those involving postpartum hemorrhage deaths were related to inadequate surgical hemostasis. In all these cases, more prompt attention to clinical signs of hemorrhage and associated hypovolemia would also have prevented death."
Elsevier Health Sciences
Nine patients died from pulmonary thromboembolism, 7 after cesarean delivery and 2 after vaginal birth. None had received peripartum thromboembolism prophylaxis in the form of either fractionated or unfractionated heparin or pneumatic compression devices.
Writing in the article, Steven L. Clark, MD, Medical Director of the Women and Newborns Clinical Program, Hospital Corporation of America, states, "In nearly every population of adult surgical patients, either medical or mechanical thromboprophylaxis reduces venous thromboembolism by approximately 70%...If one assumes similar efficacy in pregnant women, 5 of the 7 deaths from pulmonary embolism in women undergoing cesarean delivery would have been prevented if a policy of universal use of medical or mechanical thromboprophylaxis for patients undergoing cesarean had been in place. Such a policy would reduce the mortality rate attributed causally to cesarean delivery to 0.9/100,000, or approximately 9 US deaths annually, eliminating the statistical difference in deaths attributed to cesarean vs. vaginal birth." Dr. Clark notes that the Hospital Corporation of American has instituted such a policy to improved patient safety throughout their system, the largest in the United States.
Dr. Clark continues, "It seems clear that the majority of maternal deaths in the United States are not preventable. The most common preventable errors in preeclampsia management leading to maternal death involved inattention to blood pressure control and signs or symptoms of pulmonary edema; those involving postpartum hemorrhage deaths were related to inadequate surgical hemostasis. In all these cases, more prompt attention to clinical signs of hemorrhage and associated hypovolemia would also have prevented death."
Elsevier Health Sciences
Cesarean News and Current Cesarean Events RSSResearch in AJN shows increase in private and public place infant abductions
The American Journal of Nursing (AJN) announced today results from a study, based on 23 years of data collection, identifying new trends in nonfamily infant abductions.
Preterm birth contributes to growing number of infant deaths
Babies born too soon and too small accounted for a growing proportion of infant deaths, according to new statistics released today from the National Center for Health Statistics, (NCHS).
Caesarean sections associated with risk of asthma
Babies born by Caesarean section have a 50 % increased risk of developing asthma compared to babies born naturally. Emergency Caesarean sections increase the risk even further.
New method of managing risk in pregnancy leads to healthier newborns, better outcomes for moms
An alternative method for obstetric care has led to lower neonatal intensive care unit (NICU) admission rates, higher uncomplicated vaginal birth (UVB) rates, and a lower mean Adverse Outcome Index (AOI) score.
C-sections a critical factor in preterm birth increase
Cesarean sections account for nearly all of the increase in U.S. singleton preterm births, according to an analysis of nine years of national birth data.
Possible biological explanation for C-Section-linked allergies and asthma found
Scientists believe they may have identified a biological explanation for the link between cesarean-section delivery and risk of allergy and asthma in childhood.
Too much or too little weight gain poses risks to pregnant mothers, babies
Women who gain more or less than recommended amounts of weight during pregnancy are likely to increase the risk of problems for both themselves and their child, according to a new report by the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
Fetal surgeon shows for first time that laser procedure may treat vasa previa
A University of South Florida fetal surgeon at Tampa General Hospital successfully treated in utero a rare but potentially devastating condition in which placental blood vessels block the birth canal and can rupture during labor, leaving the baby without vital blood and oxygen. If undiagnosed, the condition known as vasa previa is frequently deadly for newborns.
Stop eating for two: obese moms-to-be should gain less weight than currently recommended
Severely obese women should lose weight during pregnancy, while obese women who are pregnant should gain less weight than currently recommended, a Saint Louis University study finds.
Postpartum hospital discharges -- when is the 'right time?'
A landmark nationwide study, published today in the journal Pediatrics, is the first ever to prospectively examine the decision-making process of over 4,000 mothers and their physicians around the readiness of mothers and their infants to leave the hospital after childbirth.
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