Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity

项目总结：总体 产后出血(PPH)是孕产妇死亡和严重孕产妇发病率(SMM)的主要原因，对社会边缘群体的影响不成比例。我们建议在斯坦福大学创建一个卓越的孕产妇健康研究中心，名为PRIHSM(预防与出血相关的严重孕产妇发病率中的不平等)。PRIHSM的目标是通过减少和解决与PPH相关的SMM和死亡率：剖腹产和缺铁性贫血(IDA)的重要先兆的差异来减少PPH和相关的SMM。孕妇缺铁性贫血的问题被严重低估，但在美国，它影响了大约16%的怀孕；与其他人口相比，黑人的发病率高出3-4倍，拉丁裔人的发病率高出1.5-2倍。这意味着与PPH相关的SMM的比率更高。我们建议，通过有效地解决产前IDA和这些差异，我们可以减少PPH相关的SMM。此外，几乎三分之一的美国新生儿是通过剖腹产出生的，不同医院的剖腹产率相差10倍，在低风险怀孕中，黑人和亚洲人的剖腹产率最高。虽然剖腹产在适当的时候可以是一种挽救生命的干预措施，但它与包括产后出血在内的重大风险有关。我们认为，提高出生公平性和减少产科管理的可变性是解决剖宫产相关PPH差异和减少PPH相关SMM的重要策略。因此，我们的目标是：目标1(项目1)。通过开发、实施和传播患者知情的贫血预防工具包来减少产前缺铁性贫血，该工具包将使缺铁性贫血的评估、诊断和治疗标准化，并减少缺铁性贫血的患病率以及出生时缺铁性贫血和与PPH相关的SMM的种族/族裔差异。目标2(项目2)。减少初次剖宫产率和剖腹产相关产后出血比率的差异，方法是开展一项混合方法研究，以了解医院水平上这些结果差异的驱动因素，并实施患者了解的产妇公平指南。我们的工作将涉及社区和大学的合作伙伴关系，重点是改善孕产妇健康公平，并由患者、提供者和医疗保健领导层的观点推动。我们的工作将提供培训机会，以建立与PPH相关的研究和临床专业知识，特别是在学术和社区环境中代表不同观点和经验的个人，以及服务不足的领域。我们提出了一个大胆但可实现的议程，它将影响PPH相关死亡率、发病率和差异的可持续下降。

Project Summary: Overall Postpartum hemorrhage (PPH) is a leading cause of maternal death and severe maternal morbidity (SMM) and disproportionately affects socially marginalized groups. We propose to create a Maternal Health Research Center of Excellence at Stanford University called PRIHSM (PReventing Inequities in Hemorrhage-related Severe Maternal morbidity). The goals of PRIHSM are to reduce PPH and associated SMM by reducing and addressing disparities in important precursors to PPH-related SMM and mortality: cesarean birth and iron deficiency anemia (IDA). The problem of maternal IDA is vastly under-appreciated yet it affects approximately 16% of pregnancies in the U.S.; rates are 3-4x higher among Black people and 1.5-2x higher among Latinx people compared to the rest of the population. This translates to higher rates of PPH-related SMM. We propose that by effectively addressing antenatal IDA and these disparities, we can reduce PPH-related SMM. Additionally, almost 1 in 3 U.S. births are by cesarean delivery, rates vary 10-fold across hospitals, and Black and Asian individuals have the highest prevalence of cesarean section among low-risk pregnancies. While cesarean section can be a lifesaving intervention when appropriate, it is associated with significant risks that include PPH. We propose that enhanced birth equity and reduced variability in obstetric management are important strategies in addressing disparities in cesarean-linked PPH and reducing PPH-related SMM. Thus, our Aims are to: Aim 1 (Project 1). Reduce antenatal IDA by developing, implementing, and disseminating a patient-informed Anemia Prevention Toolkit, which will standardize the evaluation, diagnosis, and treatment of IDA and reduce the prevalence of IDA and racial/ethnic disparities in IDA at birth admission and PPH-associated SMM. Aim 2 (Project 2). Reduce disparities in rates of primary cesarean birth and cesarean-linked PPH by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide. Our work will involve community-university partnerships focused on improving maternal health equity and be driven by perspectives of patients, providers, and healthcare leadership. Our work will provide training opportunities to build research and clinical expertise relevant to PPH, especially among individuals who represent diverse perspectives and experiences within academic and community-based settings, and underserved areas. We propose a bold yet achievable agenda that will affect a sustainable decline in PPH-related mortality and morbidity and disparities.