Pregnancy related deaths were recorded for the first time in the United States by the Centre for Disease Control (CDC) in 1986 following the need to investigate maternal death rates in the country from that year (Kuklina, Ayala, & Callaghan, 2009). This way, the government would determine health needs that were highlighted in the case of mothers in the country and the safety of the begotten children. This paper looks at some of the prevalent issues in maternal health in the United States.
Pregnancy related death for this purpose has been defined as the death of the woman while pregnant or at least one year after the termination of the pregnancy regardless of the reason of termination. The termination should be as a result of the pregnancy and not just incidental/accidental events that would lead to death. Data is then collected from the 52 states and epidemiologists determine the major causes of death by coding them according to prevalence (Albrecht, et al., 2010). Summary information is thus provided on the information that has been gathered for the purpose of interpretation and action plan creation. This data is then released through peer-reviewed articles, CDC guidance manuals and other health documents to address prevailing health concerns with particular regard to pregnancy-related conditions. The pregnancy related mortality ratio is used to determine the number of women among 100,000 live births die from pregnancy related complications (Kuklina & Callaghan, 2012).
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Due to improved medical technology and procedures in handling expectant women, the mortality rate fell significantly in the twentieth century. Interest was developed in the area of pregnancy related deaths, which led to research and development of methods, techniques and systems dealing with causes, review, identification and analysis of pregnancy related complications (Louie, Acosta, Jamieson, & Honein, 2010). The table below considers pregnancy related mortality ratio in the United States between 1987 and 2011.
As can be seen in the above data, there has been a steady increase in the number of maternal deaths over the last two decades from a low of 7.2 in 1987 to a high of 17.8 in 2009 and 2011. While the exact causes of the increase in maternal deaths are unclear, the increase is partially attributed to the improved systems of recording maternal and pregnancy related deaths across the states. Due to the improvement of systems, including the provision for a check box for a pregnancy, there is now more accurate reporting of pregnancy related deaths (Creanga, et al., 2012).
Additionally, it is not possible to determine whether pregnancy related causes have increased as there is evidence to show that there are an increasing number of pregnant women who already have conditions such as hypertension, diabetes and obesity before and during their pregnancy (Albrecht, et al., 2010). As a result, such women are at higher risk of pregnancy related complications. Despite the low chances that one can succumb to pregnancy related complications, there is an increased risk for women who already have cardiovascular conditions or those mentioned above.
It is important to note that the higher rates in 2009 and 2011 can be attributed to the increase in infections affecting persons as well as sepsis deaths. The outbreak of the influenza A pandemic, also known as H1N1, could have been a factor of consideration since the larger majority of the population was equally affected. During the 15-month outbreak window, the flu accounted for 12% of the lives lost that could be classified as pregnancy related. Increased variations in studies can be conducted to determine if demographic factors such as age, race and ethnicity were determinant factors during this 15-month window (Louie, Acosta, Jamieson, & Honein, 2010). As such, pregnancy related deaths would be significantly reduced.
The CDC has since conducted research into the various causes of pregnancy related deaths and has come up with the following table showing the frequency of each cause among pregnancy related deaths in women:
As has been discussed above, a significant number of women succumb to health-related issues that were present before the pregnancy. This is because some are exposed to conditions including cardiovascular diseases, hypertension and other medical conditions before pregnancy, increasing their risk during pregnancy. As a result, they are more prone to health risks during or immediately after pregnancy. Thus hemorrhage comes in as a risk because of factors such as blood pressure. In other cases, however, women will succumb to other health risks that are present including infection, amniotic fluid embolism among others. However, 6.2% of all pregnancy related deaths still have an unknown cause, which opens areas for research into other possible causes for pregnancy related deaths.
In conclusion, reporting on pregnancy related deaths requires accurate information collection methods and succinct causes of death to determine whether or not the death was pregnancy related. After that, the classification for the cause of death should be done to determine the exact cause and tis classification for ease of data presentation.
References
Albrecht, S. S., Kuklina, E. V., Bansil, P., Jamieson, D. J., Whiteman, M. K., Kourtis, A. P., & Callaghan, W. M. (2010). Diabetes trends among delivery hospitalizations in the US, 1994–2004. Diabetes care, 33(4) , 768-773.
Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2012). Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993–2006. Obstetrics & Gynecology, 120(2, Part 1) , 261-268.
Kuklina, E., & Callaghan, W. (2012). Chronic Heart Disease and Severe Obstetric Morbidity Among Hospitalizations for Pregnancy in the USA: 1995–2006. Obstetric Anesthesia Digest, 32(1) , 17-18.
Kuklina, E., Ayala, C., & Callaghan, W. (2009). Hypertensive disorders and severe obstetric morbidity in the United States: 1998-2006. Obstet Gynecol., 113(6) , 1299-1306.
Louie, J. K., Acosta, M., Jamieson, D. J., & Honein, M. A. (2010). Severe 2009 H1N1 influenza in pregnant and postpartum women in California. New England Journal of Medicine, 362(1) , 27-35.
