Maternal Mortality Data Final Articles Where Immediate Connections

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001799/pdf/nihms810951.pdf
Data analysis of maternal mortality in United States
Folder (Hameed)California initiative, like North Carolina Initiative
https://www.ajog.org/article/S0002-9378(15)00457-3/fulltext
https://jhu.pure.elsevier.com/en/publications/pregnancy-related-mortality-in-the-united-states-2006-2010
More data on U.S. maternal mortality
https://www.npeu.ox.ac.uk/downloads/files/reports/Safely%20delivered%20NMS%202014.pdf
Folder (UK) More states should be like California and North Carolina, and do something like the UK
https://linkinghub.elsevier.com/retrieve/pii/S0140673615008387
Data on global maternal mortality https://jhu.pure.elsevier.com/en/publications/pregnancy-related-mortality-in-the-united-states-2006-2010
Folder (Creanga)Didn't use All of the initiatives are pretty similar - they all focus on antenatal care
Data on initiatives to reduce maternal mortality from cardiovascular
Folder
disease
(North Carolina)
If a similar initiative was launched in another state, it will likely have the same success rate as the others
https://www.publichealth.nc.gov/docs/2018-NC-MedicalSocietyLegislativeReport-101518.pdf
Pregnancy-related cardiovascularhttp://healthymaryland.org/wp-content/uploads/2018/05/MMR-Report-2017__FINAL.pdf
deaths in California:
https://www.ajog.org/article/S0002-9378(15)00457-3/fulltext Folderbeyond
(Maryland
peripartum
Maternal
Maternalmortality
cardiomyopathy
Mortalityin Review)
Maryland
(in folder)
is a problem
California other article (in folder) Although the Maryland state government is currently trying to alleviate the problem, their focus is mainly on drug use during pregnancy
https://www.cmqcc.org/news/publication-pregnancy-related-cardiovascular-deaths-california-beyond-peripartum-cardiomyopathy
Annual Report to the North Carolina Medical Society (in folder) There should be an initiative in Maryland focused on cardiovascular disease during pregnancy - it could help significantly reduce the rate of maternal mortality
https://www.publichealth.nc.gov/docs/2018-NC-MedicalSocietyLegislativeReport-101518.pdf
Maryland maternal mortality report (in folder)
http://healthymaryland.org/wp-content/uploads/2018/05/MMR-Report-2017__FINAL.pdf Other states should also do initiatives, but Maryland for sake of feasibility
https://www.npeu.ox.ac.uk/downloads/files/reports/Safely%20delivered%20NMS%202014.pdf
UK initiative All articles prove that maternal mortality is a problem and that there is a way to combat it
http://reviewtoaction.org/sites/default/files/national-portal-material/Report%20from%20Nine%20MMRCs%20final_0.pdf
Nine states maternal mortality
https://www.mhtf.org/2018/03/16/new-data-explore-why-preventable-maternal-deaths-continue-to-occur-in-the-united-states/
Data on cardiovascular disease during pregnancy
Study on pregnant women with congenital heart disease
https://heart.bmj.com/content/heartjnl/96/20/1656.full.pdf
file:///Users/navyakrishna/Downloads/Flo_et_al-2010-BJOG%253A_An_International_Journal_of_Obstetrics_%2526_Gynaecology.pdf
Study measuring cardiac output during pregnancy
FIRST ARTICLE DATA AND ANALYSIS
Folder (Hameed pt. 2)
https://www.ajog.org/article/S0002-9378(15)00457-3/fulltext
Data Points From 2002 to 2006, there were 2,741,220 California women who gave birth or had a fetal demise and 864 women who died while pregnant or within 1 year of pregnancy.
Among the pregnancy- related deaths, nearly a quarter (n 1⁄4 64) were due to CVD, for an incidence rate of 2.35 CVD deaths per 100,000 live births.
Women who died from CVD had a higher frequency of documented substance use than women who died from non-CVD causes (23.7% vs 9.4%; P < .01)
Among all CVD pregnancy-related deaths, 1 (1.6%) occurred prior to delivery and 70.3% occurred in the early postpartum period (ie, 42 or fewer days from delivery)
Deaths among women with CVD were more likely to occur beyond the 6 week postpartum period compared with women with non-CVD deaths (29.7% vs 7.3%; P < .001)
Only 5% of other cardiovascular deaths occurred in the late postpartum period compared with 40% of all cardiomyopathy deaths and 55% of dilated cardiomyopathy deaths
Eighty-four percent of women who died from CVD presented with symptoms suggestive of cardiopulmonary disease (ie, shortness of breath, palpitations, chest pain, wheezing, or fatigue), which manifested during pregnancy or in the postpartum period.
Among the symptomatic women, 61.1% received a referral to a cardiologist for further evaluation; however, only 7% were referred in the prenatal period. The remaining referrals occurred around labor and delivery or postpartum.
Only 2 women were diagnosed with CVD prior to delivery, even though 11 women presented with at least 1 symptom consistent with cardiovascular disease during the pregnancy.
A delay in diagnosis based on failure to respond to clinical warning signs in the history and physical examination was a contributing factor in 45% of the dilated cardiomyopathy deaths (in the study)
the CA-PAMR Committee determined that there was a good to strong chance to alter the outcome in 23.8% of the cardiovascular deaths
Patient and health care provider factors contributed to 70.3% and 68.8% of CVD deaths, respectively
Contributing patient factors included underlying medical conditions (64.1%), delay in seeking care (31.3%), obesity (28.1%), presumed or potential lack of awareness regarding the significance of their condition (21.9%), and substance abuse (18.8%)
Health care provider factors included delayed response or management, including diagnosis and treatment (60.9%), ineffective care or treatment (39.1%), misdiagnosis (37.5%), failure to refer or consult (29.7%), and lack of continuity of care (26.6%)
Analysis In the study conducted by the authors, the results show that cardiovascular disease was a major cause of maternal mortality, and that many of the deaths were preventable
A major problem identified in the study was that there were both patient and healthcare factors that have have contributed to the maternal mortality rate
After this study, the CMQCC launched an intiative to reduce maternal mortality from cardiovascular disease
Charts/Graphs
SECOND ARTICLE DATA AND ANALYSIS
https://www.npeu.ox.ac.uk/downloads/files/reports/Safely%20delivered%20NMS%202014.pdf
Folder (UK)
Data Points 98% of women in the study had antenatal checks and 1% had no check ups
95% of women in the study saw a midwife, 31% saw an obstetrician at least once and 15% saw their general practitioner at least once
99% of women reported having an anomaly or '20 week' scan
Women had an average of 3.9 scans each
Compared to in 2006 and 2010, women in 2014 accessed antenatal care earlier, booked for their maternity care earlier and there was greater uptake of antenatal screening
96% of women had contacted a health professional about their pregnancy by the time they were 12 weeks pregnant and 91% had attended a booking appointment
Some women had long-term health problems and others had problems arising in the course of their pregnancy and recieved additional care
89% attended a specialist antenatal clinic

Analysis Many women in the UK recieve antenatal care

The rate of maternal mortality in the UK is lower than the rate in the US
The maternal mortality rate in the US could be lowered with more access to antenatal care
Another way to lower the US maternal mortality rate is to improve the quality of antenatal care and to ensure that every woman has access to preventative measures

Charts/Graphs
THIRD ARTICLE DATA AND ANALYSIS
Folder (North Carolina)
https://www.publichealth.nc.gov/docs/2018-NC-MedicalSocietyLegislativeReport-101518.pdf
Data Points North Carolina Child Fatality Task Force
Child Fatality Prevention System Summit
Community Focused Infant Mortality
Improving Community Outcomes for Maternal and Child Health
Maternal Health Services
Pregnancy Medical Home initiative, Pregnancy Care Management services
Maternal Mortality Review legislation
Mostly concerned with smoking during pregnancy: one of the leading causes of maternal mortality
https://schs.dph.ncdhhs.gov/data/maternal/
Main causes of pregnancy-related deaths
17.89% cardiomyopathy
13.68% cardiovascular disease
11.05% hypertensive disorders of pregnancy
12.11% pulmonary embolism
7.89% hemorrhage
Analysis North Carolina has implemented many programs to ensure maternal and infant safety
Other states should do the same
If more states followed North Carolina's lead, the overall maternal mortality rate in the US would decrease
Charts/Graphs
FOURTH ARTICLE DATA AND ANALYSIS
Folder (Maryland Maternal Mortality Review
http://healthymaryland.org/wp-content/uploads/2018/05/MMR-Report-2017__FINAL.pdf
Data Points Second leading cause of pregnancy-related death in 2015 was thrombotic pulmonary embolism
Many pregnany-related deaths in 2015 occured postpartum, 0-42 days after pregnancy
As is seen in the first graph below, the maternal mortality rate of the US was 19.6 from 2006-2010 and Maryland's was 21.8. From 2011-2015, the US maternal mortality was 26.9 and Maryland's was 26.0.
Between the two 5-year periods shown, the U.S. MMR increased by 37 percent and the Maryland rate increased by 19 percent
Analysis Maryland needs an initiative to reduce its maternal mortality
Even though the Maryland maternal mortality during 2011-2015 was lower than the US maternal mortality, it has still increased since 2006-2010
Maryland is trying to reduce their maternal mortality, but they are approaching drug abuse during pregnancy
This initiative is pretty recent, so there isn't much concrete data
Charts/Graphs