MaternalMortalityandHemorrhage.pptVIP

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MaternalMortalityandHemorrhage.ppt

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MaternalMortalityandHemorrhage

Maternal Mortality and Hemorrhage Gina M. Brown, MD NYC Department of Health and Mental Hygiene Bureau of Maternal, Infant and Reproductive Health Special Thanks to: Candace Mulready, MPH Katrina Manzano, MPH Vani Bettegowda, MHS Office of Vital Statistics Office of the City Medical Examiner SPARCS Bureau of Maternal, Infant and Reproductive Health US Historical Perspective: Racial Disparities Trends in Maternal Mortality Ratio NYC, 1993-2002 BMIRH MMR Enhanced Surveillance Methods Case ascertainment Vital Statistics, Medical Examiner, SPARCS Case Review Medical records, ME reports, maternal death certificates, infant birth certificates Data entry and analysis NYC MMR Review 1998-2000BMIRH Enhanced Surveillance Referral Source of Maternal DeathsBMIRH 1998-2000 CDC/ACOG Categorization of Maternal Deaths BMIRH 1998-2000 Location of DeathBMIRH 1998-2000 Timing of Death After DeliveryBMIRH 1998-2000 Percent of Live Births and Maternal Deaths By Race/Ethnicity BMIRH 1998-2000 Concurrent Morbidity: ObesityBMIRH 1998-2000 (n =169) Obese 24% Not Obese 44% Missing 33% Weight 200 lbs 20% at delivery Comparing Leading Causes of Death (%) Hemorrhage Related DeathsBMIRH 1998-2000 Black 64 % Hispanic 21 % White 8 % Asian/Pacific Isl. 8 % In hospital 97% Hemorrhage Deaths*% Related Causen=39 Abnormal Coagulation DIC/ Coagulopathy Amniotic Fluid Embolism HELLP syndrome Abruptio placenta Active bleeding Uterine atony Placenta other Placenta previa Unspecified/Unknown * Coagulopathy is the final common pathway 31% 13% 10% 5% 3% 28% 15% 8% 5% 36% Pregnancy Outcome %All Deaths vs. Hemorrhage Obesity: Maternal Mortality Risk From HemorrhageBMIRH 1998-2000 Hemorrhage 1/ 1000 deliveries Likely Previa, Abruptio, uterine distension, previous history, Uterine rupture Unanticipated Uterine atony Post partum Physiologic Response to Pregnancy Increased vascular volume Decreased systemic vascular resistance Increased HR Incr