Morbidity and Mortality
Maternal Morbidity and Mortality in the U.S.
General Facts
- The U.S. has a relatively low maternal mortality and morbidity as compared to with developed countries.
- Much progress has been made with the maternal population throughout the 20th century toward treating and preventing maternal disease and complications, which has contributed to lower mortality and morbidity in the U.S. In 1900 the maternal mortality rate, according to the CDC, was 900 maternal deaths per 100,000 live births, where as in 1999 the reported rate was 13.2 for 100,000 live births.
- However, in 1998 the CDC reported that the rates of maternal deaths have not declined in the U.S. since 1982 (Centers for Disease Control and Prevention, 1998, as cited in Geller, Cox, Callaghan, & Berg, 2006).
- It is reported based on evidence and research that at least half of all maternal deaths in the United States may in fact be preventable through such methods as changing providers, changes in the patient such as supportive environment in pregnancy, and compliance with recommended maternal care (Geller et al., 2006).
- In the U.S. the mortality for pregnant woman are higher in certain racial and ethnic groups as compared to others. In 2001, the CDC reported that black and Hispanic women are 1.6 times more at risk for a pregnancy related death (Geller et al., 2006).
- In the past maternal morbidity and mortality have been researched and studied as separate subjects, however more recent studies combine them in order to improve ways to identify quality maternal care concerns that may prevent or reduce both morbidity and mortality for this population (Geller et al.,2006).
Maternal Morbidity
- Maternal Morbidity is defined as "any change or departure, subjective or objective, from a state of physiological or psychological well being during pregnancy and includes the postpartum period from 42 days until 1 year” (Boulvain, 2008).
- In the U.S., maternal morbidity affects approximately 1.7 million women a year which demonstrates that the morbidity is still a large health problem and concern (Geller et al., 2006).
Highest at risk:
- Women with less socio-economic means
- Single / unmarried women
- Adolescents
- African-American women
Primary and most common forms of morbidity in the U.S. pregnancy population
- Pre-eclampsia, eclampsia
- Gestational Diabetes
- Obesity
- Depression
- Hemorrhage
- Ectopic Pregnancy
- Placenta disorders
- Stillbirth
- Preterm delivery
- Induced abortion
- Premature rupture of membranes
Maternal Mortality
Maternal mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causes” (The World Health Organization, 2003, as cited in Geller et al., 2006, p. 177).
Highest at risk:
Highest at risk:
- African American women
- Women over the age of 35
- Those with less socioeconomic means which makes for a decrease compliance for proper prenatal care due to lack of resources available. (Coeytaux, Bingham, & Strauss, 2011)
Primary and most common forms of mortality in the U.S. pregnancy population
- Embolism (thromboembolic, pulmonary, and amniotic)
- Hemorrhage
- Complications of medical conditions
- Preeclampsia, Eclampsia
- Ectopic Pregnancy
- Infection
- Cardiomyopathy
- Placenta abruption
- Placenta Previa
What do we need to know as clinicians?
- According to many organizations such as WHO, UNICEF, UNFPA about half of all maternal deaths in the U.S. are preventable.
- Proper prenatal care is vital to this population, no matter what the economic situation.
- Proper prenatal, intrapartum, and postpartum care and follow ups are necessary.
- Recommended prevention and treatment for the maternal population is as follows:
The World Health Organization refers to the preventive package as a comprehensive package:
- It provides education and information at the community level about safe motherhood, danger signs for pregnant women and possible complications for adolescents and adults. It provides prevention services such as nutritional advice, proper vitamin supplementation, monitoring, screenings, and treatment and screenings for sexually transmitted diseases and other infections prenatally. The package also includes assistance in childbirth, follow ups, and postpartum care.
Proper care and monitoring can provide prevention and treatment in the following causes of morbidity and mortality in pregnancy:
- Hypertension - proper routine checkups and medications can prevent more severe problems with hypertension and pregnancy such as convulsions, HELLP syndrome, and preterm labor.
- Hemorrhage - Prompt medications and health care along with proper uterine massage postpartum
- Sepsis - proper clean delivery, screenings for infection and STDs
- Obstructed or prolonged labor - this more commonly seen in developed countries or poverty populations in adolescent or underdeveloped adolescents who are receiving malnutrition and their bodies are not properly developed for labor. The key here is proper contraception and preventing unwanted pregnancies.
Barriers to proper preconception / prenatal care in the U.S.
- Many women have complications before they even conceive. It is estimated that at least half of all pregnancies in the U.S. are unplanned and not intended. It is estimated in many of these cases, that the women are uninsured and lack proper prenatal care, therefore they are more likely to face pregnancy complications.
- Women with no prenatal care are 3-4 times more likely to face maternal mortality.
- It is estimated that in the U.S. there about 8 million women without affordable family planning services and information.
- Many facilities that do provide prenatal care to low income communities are overcrowded and understaffed and in turn create poor quality prenatal care which can increase morbidity and mortality.