1、Dr. John Choate Memorial Lecture,Safe Motherhood Project Update-2004,Learning Objectives,Comprehend the worldwide impact List the issues in New York State and NYC Understand the District II-SMI Project Discuss the medical and systems issues Appreciate the need for local “action” Recognize the opport
2、unity for involvement,Maternal Mortality: Why Must We Still Be Interested?,Measure of the overall effectiveness of our obstetric and general health care system. Provides a sentinel indicator of problems or “gaps” in the health care system.,Daily Death Toll: during pregnancy & in childbirth,WORLDWIDE
3、,Worldwide Causes of Maternal Deaths,Severe bleeding 25%,Sepsis 15%,Eclampsia 12%,Obstructed labor 8%,Unsafe abortion 13%,Indirect causes 19%,Other direct causes 8%,United KingdomConfidential Enquiries,Confidential Enquiry,Inception 1952 a triennial report Government requires all maternal deaths be
4、subject to CEMD All relevant hospital professionals & other health professionals must participate in the CEMD,Direct Maternal Deaths,Why Mothers Die 1997 - 1999, CEMD,Intervention !,Facts about TE,5 fold increased risk during pregnancy Absolute risk of VT is 0.5 - 3 per 1,000 PE remains a leading ca
5、use of maternal death in United States 50% of women with a thrombotic event in pregnancy have an underlying congenital or acquired thrombophilia,Frightening Fact,In about 50% of patients with a hereditary thrombophilia, the initial thrombotic event occurs in the presence of an additional risk factor
6、 pregnancy BCP usage orthopedic trauma or immobilization surgery,Our Patients !,RCOG - Prophylaxis After C/Section,Age 35 years Obesity 80 kg Parity four or more Labor 12 hours Gross varicose veins,Emergency C/S Pre-op immobility (4 days) Preeclampsia Current infection Other major illness,* Heparin
7、OR mechanical methods (stockings or SCD boots),Moderate Risk*,RCOG - Prophylaxis After C/Section, 3 moderate risks Personal hx of DVT, PE, thrombophilia, or paralysis,Extended C/S C/Hyst Patients with ACA Family history of DVT or PE,* Heparin AND mechanical methods (stockings or SCD boots),High Risk
8、*,RCOG - Air Travel Recommendations,Low-dose aspirin is an acceptable alternative, 3 days before and day of,Maternal Mortality: Nationally and in New York State,US Healthy People 2010 Goal: 3.3 Per 100,000 livebirths,Maternal Mortality: NYS vs. Nation 1987 - 2001,Maternal Mortality Ratios 1987 - 199
9、6,National: 7.7 / 100,000 (1987-1996),US Trend in Cause of Pregnancy-Related Death* by Year,* Deaths among women with a livebirth,THE Number 1 Cause,Pregnancy-Related Mortality Ratio (PRMR)* by Race & Age US, 1991 - 1997,Source: CDC, 2002.,* Deaths among women with a livebirth,Maternal Mortality Rat
10、ios for Caucasian Women:1987-1996,Note: The colors on these maps show the statesdivided into three terciles based on their MMR.,Maternal Mortality Ratios for African-American Women 1987-1996,Source: NCHS, Vital statistics,15.9 in NYS,2000 NYS Maternal Mortality Ratios,*Per 100,000 livebirths,9.5 in
11、Upstate New York,23.1 in NYC,New York City Maternal Deaths Direct & Indirect 1998 - 2000,119 cases out of 169 Total Hemorrhage 32% Hypertension 10% Cardiomyopathy 8% Embolism 7% Infection/Sepsis 7% Anesthesia 7%,Courtesy of Dr. Gina Brown, NYCDOH, BMIRH,NYC Maternal Deaths,Courtesy of Dr. Gina Brown
12、, NYCDOH, BMIRH,Location and Timing of Death,70 % Died in the hospital 45% Died within 24 hours of birth,Courtesy of Dr. Gina Brown, NYCDOH, BMIRH,Hemorrhage Deaths Related Causes N = 39,HELLP 5% Previa 5% Atony/PP Hem 15% A/Per/Increta 5% Coagulopathy 13%,AFE 10% Abruptio 3% Ectopic 5% Other placen
13、ta 3% Unspec/Unknown 36%,Courtesy of Dr. Gina Brown, NYCDOH, BMIRH,Approximately one-half of all maternal deaths are considered to be preventable!,NYS Safe Motherhood Project,Proposal drafted by Dr. John Choate Patterned after the Confidential Enquiry Developed with NYS/District II Funded by Commiss
14、ioners Priority Pool Protected by PHL 206 (1)(j) ACOG Partners with RPCs Quality expectation On-site death review teams,Issues to Review: Quality and Content of Medical Care,Preventive services - chronic illnesses Community and patient education Nutrition, substance abuse, social services Preconcept
15、ion counseling Prenatal care access Labor and delivery care Consulting Services Postpartum care and follow-up,Source: CDC, 2002.,Issues to Review: Systems and Social Causes of Death,Intendedness of pregnancy Woman and her familys knowledge and decision making ability Timeliness of womans actions to
16、seek care Accessibility and acceptability of care,Source: CDC, 2002.,Methods to Identify Deaths,Death Certificates: Primary source Linkage to and Searches of other databases Reports from providers, hospitals, clinics, medical examiners, ED physicians, media Review of autopsy and medical records Comp
17、uter linkage of vital records,CAUSE OF DEATH,CONFIDENTIAL SEE INSTRUCTION SHEET FOR COMPLETING CAUSE OF DEATH CONFIDENTIAL,30. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR (A), (B), AND (C),APPROXIMATE INTERVAL BETWEEN ONSET AND DEATH,PART I. IMMEDIATE CAUSE:(A),DUE TO OR AS A CONSEQUENCE
18、 OF:(B),DUE TO OR AS A CONSEQUENCE OF:(C),PART II OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO CAUSE GIVEN IN PART I (A):,31A. IF INJURY DATE:MONTH DAY YEAR,HOUR:,m,31B. LOCALITY: (City or town and county and state),31C. DESCRIBE HOW INJURY OCCURRED,31D. PLACE OF INJURY,33A.
19、 IF FEMALE WAS DECEDENTPREGNANT IN LAST 6 MONTHS?NO YES0 1,33B. DATE OF DELIVERY:,MONTH DAY YEAR,Safe Motherhood Initiative,The American College of Ob-Gyn District II/ NYChair: Jeffrey C. King, MD, FACOG Project Director: Cathy Chazen Stone, MSNeisha M. Torres, RN, MS Executive Director: Donna Monta
20、lto Williams, MPP,Contracted by the Womens Health Bureau, NYS Department of Health,NYS Regional Perinatal Network expects the RPCs to conduct quality assurance and quality improvement activities with their affiliate hospitals.,The Safe Motherhood Initiative uses, review of all maternal deaths is par
21、t of that role.,Maternal Mortality Review Team,Maternal-Fetal Medicine/RPCLabor & Delivery nurse/RPCor Nurse coordinator/RPCGeneral Ob-Gyn/ACOGProject Director/ACOGSub-specialist/RPC (as needed),Recommendations,SMI Project Summary,Death notifications = 21, Review = 15, Pending = 2 Cause of Death Sep
22、sis 4 Embolism 3 Hypertensive Disease 5 Hemorrhage 1 Congenital Cardiac Disease 1 Unknown 1,SMI Project Summary,Ethnicity White 30% Asian 8% Haitian 8% Black 46% Hispanic 8%,Age40 11%,Issues Identified,Medical Care recognition and transfer Blood bank procedure EMS protocols & ED process Availability
23、 of Diagnostic studies Translation Services Grief Counseling for Family and Staff Consulting issues willingness and adequacy,What Can You Do?,Review your institutional Policy and Procedures Encourage Emergency Drills Confront Cultural Competency Admit Your Limitations,Remember:Its The Patient That R
24、eally Matters!,For more information contact,Cathy Chazen Stone, MS Project Director, Safe Motherhood Initiative American College of Obstetricians and Gynecologists, District II/ NY 152 Washington Avenue Albany, New York 12210 Telephone: 518.436.3461 Fax: 518.426.4728 Email: cstoneny.acog.org,Learnin
25、g Objectives,Comprehend the worldwide impact List the issues in New York State and NYC Understand the District II-SMI Project Discuss the medical and systems issues Appreciate the need for local “action” Recognize the opportunity for involvement,My Thanks to All Who Have Supported and Contributed To the Success of This Project,Jeffrey C. King, MD, FACOG Chair, Safe Motherhood Initiative NYS/ACOG Professor and Chair New York Medical College,Thanks to All Supporting This Project !,
