Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions.
Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions.
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DOI：
10.1542/neo.20-10-e561
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发表时间：
2019-10-01
期刊：
影响因子：
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通讯作者：
Molina, Rose L
中科院分区：
文献类型：
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作者：
Collier, Ai-Ris Y;Molina, Rose L
在过去20年中，美国与怀孕有关的死亡人数呈上升趋势，这在与怀孕有关的死亡人数下降的其他高收入国家中尤为突出。心肌病和其他心血管疾病、出血和其他慢性疾病都是死亡的重要原因。因暴力、药物过量和自我伤害造成的意外死亡是需要医疗和公共卫生关注的新原因。在妊娠护理方面存在着明显的种族/族裔不平等，非西班牙裔黑人妇女与妊娠有关的死亡率比非西班牙裔白色妇女高3至4倍。在美国，不同的术语和缺乏确定孕产妇死亡的标准化方法导致了细致入微的数据收集和解释挑战。国家孕产妇死亡率审查委员会是收集和解释孕产妇死亡原因、时间和可预防性数据的重要机制。重要的是，对每例孕产妇死亡进行彻底的标准化审查，从而提出预防未来妊娠相关死亡的建议。改善孕产妇健康结果的关键干预措施包括：（1）在孕前护理、怀孕、产后及以后，为患有高风险合并症的妇女提供多学科护理;（2）解决结构性种族主义和健康的社会决定因素;（3）通过团队培训和模拟，在医院范围内实施安全捆绑;（4）为患者提供关于妊娠并发症早期预警信号的教育;以及5）将产妇护理水平区域化，以便有风险因素的妇女在有专门护理团队的设施中分娩时得到支持。
The rising trend in pregnancy-related deaths during the past 2 decades in the United States stands out among other high-income countries where pregnancy-related deaths are declining. Cardiomyopathy and other cardiovascular conditions, hemorrhage, and other chronic medical conditions are all important causes of death. Unintentional death from violence, overdose, and self-harm are emerging causes that require medical and public health attention. Significant racial/ethnic inequities exist in pregnancy care with non-Hispanic black women incurring 3 to 4 times higher rates of pregnancy-related death than non-Hispanic white women. Varied terminology and lack of standardized methods for identifying maternal deaths in the United States have resulted in nuanced data collection and interpretation challenges. State maternal mortality review committees are important mechanisms for capturing and interpreting data on cause, timing, and preventability of maternal deaths. Importantly, a thorough standardized review of each maternal death leads to recommendations to prevent future pregnancy-associated deaths. Key interventions to improve maternal health outcomes include 1) integrating multidisciplinary care for women with high-risk comorbidities during preconception care, pregnancy, postpartum, and beyond; 2) addressing structural racism and the social determinants of health; 3) implementing hospital-wide safety bundles with team training and simulation; 4) providing patient education on early warning signs for medical complications of pregnancy; and 5) regionalizing maternal levels of care so that women with risk factors are supported when delivering at facilities with specialized care teams.