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2.
J Natl Med Assoc ; 113(1): 105-113, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33339616

ABSTRACT

Black enslaved women endured sexual exploitation and reproductive manipulation to produce a labor workforce on the southern plantations during the Antebellum Period. Health care inequity has continued from slavery and into the 21th century primarily due of racial segregation, poverty, access, poor quality of care, eugenics and the assault of forced sterilizations. Racial disparity in maternal and infant mortality is an outcome rooted in racial injustice, social and economic determinants as well as the stresses during pregnancy throughout the generations of Black births. Affordable, available, quality and equitable care and narrowing the economic gap for Black women and families is the most significant barrier in combating racial disparity in perinatal health outcomes and health inequity.


Subject(s)
Social Segregation , White People , Black or African American , Female , Humans , Infant , Infant Mortality , Pregnancy , Racial Groups
3.
Clin Obstet Gynecol ; 62(4): 846-856, 2019 12.
Article in English | MEDLINE | ID: mdl-31192819

ABSTRACT

As more women at increased risk for tuberculosis (TB) reactivation immigrate to the United States, perinatal screening and chemoprophylaxis are increasingly important. Interferon-gamma release assays and the tuberculin skin test are acceptable screening tests with the latter supported by more data in pregnancy. Women screening positive should have active TB excluded, and if negative, latent TB is likely. Prophylaxis should be deferred until 3 months postpartum except in those severely immunosuppressed, human immunodeficiency virus positive, or recently exposed. Isoniazid with pyridoxine for 9 months is preferred with reasonable safety in pregnancy and breastfeeding. Monitoring for maternal hepatotoxicity is recommended.


Subject(s)
Antibiotic Prophylaxis/methods , Antitubercular Agents/administration & dosage , Pregnancy Complications, Infectious/prevention & control , Prenatal Diagnosis/methods , Tuberculosis/prevention & control , Adult , Drug Therapy, Combination , Female , Humans , Interferon-gamma Release Tests , Isoniazid/administration & dosage , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/microbiology , Pyridoxine/administration & dosage , Tuberculin Test , Tuberculosis/diagnosis , Tuberculosis/microbiology
4.
Matern Child Health J ; 22(2): 204-215, 2018 02.
Article in English | MEDLINE | ID: mdl-29119477

ABSTRACT

Objectives To examine pregnancy-related deaths (PRDs) in Florida, to identify quality improvement (QI) opportunities, and to recommend strategies aimed at reducing maternal mortality. Methods The Florida Pregnancy-Associated Mortality Review (PAMR) Committee reviewed PRDs occurring between 1999 and 2012. The PAMR Committee determined causes of PRDs, identified contributing factors, and generated recommendations for prevention and quality improvement. Information from the PAMR data registry, and live births from Florida vital statistic data were used to calculate pregnancy-related mortality ratios (PRMR) and PRD univariate risk ratios (RR) with 95% confidence intervals (CI). Results Between 1999 and 2012, the PRMR fluctuated between 14.7 and 26.2 PRDs per 100,000 live births. The five leading causes of PRD were hypertensive disorders (15.5%), hemorrhage (15.2%), infection (12.7%), cardiomyopathy (11.1%), and thrombotic embolism (10.2%), which accounted for 65% of PRDs. Principal contributing factors were morbid obesity (RR = 7.0, 95% CI 4.9-10.0) and late/no prenatal care (RR = 4.2, 95% CI 3.1-5.6). The PRMR for black women was three-fold higher (RR = 3.3, 95% CI 2.7-4.0) than white women. Among the five leading causes of PRDs, 42.5% had at least one clinical care or health care system QI opportunity. Two-third of these were associated with clinical quality of care, which included standards of care, coordination, collaboration, and communication. The QI opportunities varied by PRD cause, but not by race/ethnicity. Conclusion Gaps in clinical care or health care systems were assessed as the primary factors in over 40% of PRDs leading the PAMR Committee to generate QI recommendations for clinical care and health care systems.


Subject(s)
Maternal Death/etiology , Maternal Mortality , Pregnancy Complications/mortality , Quality Improvement , Adult , California/epidemiology , Cause of Death , Female , Florida/epidemiology , Humans , Population Surveillance , Pregnancy , Prenatal Care
6.
Matern Child Health J ; 18(8): 1893-904, 2014 Oct.
Article in English | MEDLINE | ID: mdl-24463941

ABSTRACT

Non-medically indicated (NMI) deliveries prior to 39 weeks increase the risk of neonatal mortality, excess morbidity, and health care costs. The study's purpose was to identify maternal and hospital characteristics associated with NMI deliveries prior to 39 weeks. The study included 207,775 births to women without a previous cesarean and 38,316 births to women with a previous cesarean, using data from Florida's 2006-2007 linked birth certificate and inpatient record file. Adjusted risk ratios (ARR) and 95 % confidence intervals (CI) for characteristics were calculated using generalized estimating equation for multinomial logistic regression. Among women without a previous cesarean, NMI deliveries occurred in 18,368 births (8.8 %). Non-medically indicated inductions were more likely in women who were non-Hispanic white (ARR: 1.41, 95 % CI 1.31-1.52), privately-insured (ARR: 1.42, 95 % CI 1.26-1.59), and delivered in hospitals with <500 births per year. Non-medically indicated primary cesareans were more likely in women who were older than 35 years (ARR: 2.96, 95 % CI 2.51-3.50), non-Hispanic white (ARR: 1.44, 95 % CI 1.30-1.59), and privately-insured (ARR: 1.43, 95 % CI 1.17-1.73). Non-medically indicated primary cesareans were also more likely to occur in hospitals with <30 % nurse-midwife births, <500 births per year, and in large metro areas. Among women with previous cesarean, NMI repeat cesareans occurred in 16,746 births (43.7 %). Only weak risk factors were identified for NMI repeat cesareans. The risk factors identified varied by NMI outcome. This information can be used to inform educational campaigns and identify hospitals that may benefit from quality improvement efforts.


Subject(s)
Cesarean Section/statistics & numerical data , Gestational Age , Hospitals/statistics & numerical data , Labor, Induced/statistics & numerical data , Adult , Black or African American/statistics & numerical data , Age Distribution , Databases, Factual , Delivery, Obstetric , Female , Florida , Hispanic or Latino/statistics & numerical data , Humans , Insurance, Health/statistics & numerical data , Logistic Models , Midwifery/statistics & numerical data , Risk Factors , Socioeconomic Factors , White People/statistics & numerical data , Young Adult
7.
Clin Obstet Gynecol ; 56(1): 154-65, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23337846

ABSTRACT

Recognition that use and abuse of substances by pregnant patients perpetuates, despite ongoing efforts to educate the public, necessitates clinicians to integrate understanding of potential effects on antepartum and intrapartum fetal testing into their interpretation and implementation of clinical findings. This includes acknowledging some anticipated alterations in results and selecting the appropriate type and frequency of testing methods and interventions. Certain substances are well documented in terms of expected variations in test results; others are not as clearly defined. An overview of information that may be helpful to the clinician is presented to promote understanding of fetal evaluation performed through common tests such as contraction stress test, the nonstress test, the biophysical profile, the modified biophysical profile, fetal movement counting, and Doppler velocimetry. What evidence is available should be used to assist in defining the actual status of the fetus as best as possible, even when the effects of substances may be unknown or have obscure results.


Subject(s)
Cocaine/adverse effects , Fetal Movement/drug effects , Heart Rate, Fetal/drug effects , Methadone/adverse effects , Narcotics/adverse effects , Pregnancy Complications , Smoking/adverse effects , Substance-Related Disorders/complications , Alcohol Drinking/adverse effects , Biophysical Phenomena/drug effects , Blood Flow Velocity/drug effects , Female , Heroin/adverse effects , Humans , Pregnancy , Umbilical Arteries/physiopathology
8.
Matern Child Health J ; 17(7): 1230-5, 2013 Sep.
Article in English | MEDLINE | ID: mdl-22907272

ABSTRACT

This report presents findings from two state-based pregnancy-related reviews of deaths due to pulmonary embolism to describe prevalence, risk factors, and timing of symptoms and fatal events (N = 46). We examined the utility of state-based maternal mortality review teams as a means to gain more complete data on maternal deaths from which guidelines for prevention and intervention can be developed. The Florida Pregnancy-Associated Mortality Review Team and Virginia Maternal Mortality Review Team collaborated on findings from 9 years of pregnancy-related mortality review conducted in each state. Pregnancy-related deaths due to pulmonary embolism occurring within 42 days of pregnancy between 1999 and 2007 in Florida and Virginia were identified. Retrospective review of records was conducted to obtain data on timing of the fatal event in relation to the pregnancy, risk factors, and the presence and timing of symptoms suggestive of pulmonary embolism. Forty-six cases of pregnancy-related death due to pulmonary embolism were identified. The combined pregnancy-related mortality ratio (PRMR) was 1.6/100,000 live births. The PRMR for patients undergoing cesarean section delivery was 2.8 compared to 0.2 among those with vaginal deliveries (95 % CI = 1.8-4.2 and 0.1-0.5 respectively). Women aged 35 and older had the highest PRMR at 2.6/100,000 live births. BMI over 30 kg/m(2) and presence of chronic conditions were frequently identified risk factors. One in five decedents (21.7 %) reported at least two symptoms suggestive of pulmonary embolism in the days before death. This combined state-based maternal death review confirms age over 35 years, obesity, and the presence of chronic conditions are risk factors for pregnancy-related mortality due to venous thromboembolism in the US. Expanding and standardizing the process of state-based reviews offers the potential for reducing pregnancy-related mortality in the US.


Subject(s)
Delivery, Obstetric/methods , Maternal Mortality , Pregnancy Complications, Cardiovascular/mortality , Pulmonary Embolism/mortality , Adolescent , Adult , Cause of Death , Delivery, Obstetric/statistics & numerical data , Female , Florida/epidemiology , Hospital Records , Humans , Pregnancy , Prevalence , Pulmonary Embolism/etiology , Retrospective Studies , Risk Factors , Virginia/epidemiology , Young Adult
10.
Semin Perinatol ; 36(1): 31-6, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22280863

ABSTRACT

At the beginning of the 20th century, maternal mortality was a leading cause of death for women of reproductive age in the United States. Obstetrical care was not standardized, and there was a lack of universal systems for monitoring maternal deaths. Public health efforts of surveillance, along with advances in medicine and sanitation, resulted in a significant decrease in maternal deaths by the early 1980s. Today, maternal death is considered to be a rare event; however, the rates of maternal mortality have not improved in almost 3 decades. There is growing evidence that many maternal deaths can still be prevented through enhanced surveillance that influences improvements in overall health and delivery of care. This paper describes the experience of establishing and maintaining a pregnancy-associated mortality surveillance system in Florida. Emphasis is placed on the process and importance of a statewide review and the value of engagement with the medical community.


Subject(s)
Advisory Committees , Maternal Health Services/standards , Maternal Mortality , Medical Audit , Obstetrics , Quality Assurance, Health Care/standards , Delivery of Health Care/standards , Female , Florida/epidemiology , Humans , Maternal Health Services/trends , Maternal Mortality/trends , Pregnancy , Sentinel Surveillance
11.
Semin Perinatol ; 36(1): 79-83, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22280871

ABSTRACT

A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths.


Subject(s)
Abortion, Induced/mortality , Maternal Mortality/trends , Medical Audit , Postpartum Hemorrhage/mortality , Quality of Health Care/standards , Sepsis/mortality , Cause of Death , Female , Ghana/epidemiology , Humans , Infant, Newborn , Obstetric Labor Complications/mortality , Pregnancy
12.
South Med J ; 95(3): 358-9, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11902706

ABSTRACT

Although percutaneous balloon mitral valvuloplasty is known to be a safe and effective procedure during a singleton pregnancy, its use during a twin gestation is limited to a single report with a poor obstetric outcome. In the case we are reporting, a 29-year-old nulliparous patient with a twin gestation was seen at 24 weeks' gestation with congestive heart failure caused by previously undiagnosed mitral stenosis. She had successful percutaneous balloon mitral valvuloplasty, and two healthy infants were subsequently delivered at 36 weeks' gestation.


Subject(s)
Catheterization , Heart Failure/etiology , Heart Failure/therapy , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/therapy , Pregnancy Complications, Cardiovascular/therapy , Twins , Adult , Female , Gestational Age , Humans , Infant, Newborn , Pregnancy , Pregnancy Outcome
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