Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
From: R. Daniel Braun (rd.braun@gmail.com)
Wed Sep 5 21:47:49 2007
And the reason is because it WAS approved. That made the cost go way up, so
us good little cost conscious OB's used unapproved Terbutaline instead.
Dan
On 9/5/07, art fougner, md <evsono@pipeline.com> wrote:
>
> Ironic ... the only drug ever approved by the FDA for tocolysis is no
> longer in use.
>
> Art
>
> At Wed, 5 Sep 2007, Meenan, Anna wrote:
> >
> >I remember ritodrine from my residency years. My next-door neighbor
> >was receiving it in the next labor room to mine while I was in labor
> >with my oldest. It didn't work for her. Her kid was born the day
> >after mine. She also went into pulmonary edema but survived. Her
> >husband is a lawyer so of course sued everyone involved. Never did
> >hear how that came out.
> >
> >Anna Meenan, MD
> >
> >>.
> >>
> >>Once I practiced medicine in Tokeka, Kansas. While there, I received
> >>a transport
> >>of a patient in fulminant pulmonary edema from too much fluid, too much
> MgSO4,
> >>terbutaline, and ritodrine (does anybody out there remember ritodrine).
> She
> >>delivered shortly after I discontinued the tocolytics and the
> >>newborn did well.
> >>The motehr did not do well, however. She develped ARDS and died about a
> week
> >>later.
> >>
> >>The death certificate was signed by the pulmonologist. I noticed
> >>that the death
> >>certificate did not mention pregnancy anywhere, however. I was about to
> call
> >>the state vital statistics people, but since I was going to attend a
> >>meeting in
> >>Wichita about three weeks later, I held off.
> >>
> >>At the meeting, I found the lady in charge of Kansas vital statistics. I
> >>mentioned the death and that it was a maternal death. She said she
> >>knew. When I
> >>asked her how she knew, she said that she had matched the death
> >>certificate with
> >>the birth certificate and therefore was able to identify the maternal
> death.
> >>
> >>She went on to say that only about 1/3 of Kansas maternal deaths were
> noted on
> >>the death certificate. Anotehr 1/3 were found by matching birth and
> death
> >>certificates and the final 1/3 were found by people calling in to notify
> them
> >>of the maternal death (as I would have done had I not been planning to
> go to
> >>that meeting a few weeks later).
> >>
> >>In Kansas, only 1/3 of maternal deaths were identified on the death
> >>certificate.
> >>
> >>- - - -
> >>
> >>-----Original Message-----
> >>>From: Ina May Gaskin <midwifeim@earthlink.net>
> >>>Sent: Sep 5, 2007 12:31 PM
> >>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >>>Subject: Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
> >>>
> >>>You got that right, Luanna.
> >>>
> >>> From MMWR, CDC, September 4, 1998:
> >>>
> >>>"The number of deaths [maternal, which does not include those from
> >>>domestic violence] attributed to pregnancy and its complications is
> >>>estimated to be 1.3 to three times that reported in vital statistics
> >>>records."
> >>>
> >>>"Misclassification of maternal deaths occurs when the cause of death
> >>>on the death certificate does not reflect the relation between a
> >>>woman's pregnancy and her death. In addition, the inclusion of deaths
> >>>causally related to pregnancy that occur between 43 and 365 days
> >>>postpregnancy can increase the number of maternal deaths identified
> >>>by 5% - 10%." (Here, only the deaths within the first 42 days are
> >>>counted.)
> >>>
> >>> From the Green journal, October 2005:
> >>>
> >>>Underestimation of mortality causally related to pregnancy based on
> >>>ICD cause-of-death codes alone varied from 22% in France to 93% in
> >>>Massachusetts."
> >>>
> >>>Massachusetts, incidentally, is one of the states that makes the most
> >>>strenuous efforts to improve their reporting. What might the
> >>>percentage of estimated misclassification be in states that don't try
> >>>so hard?
> >>>
> >>>It's an honor system. No audit is possible. The practical meaning of
> >>>this is that we are reduced to making guesses, because we lack most
> >>>of the data that we should have. I'd like to see us value women's
> >>>lives more highly than this situation indicates.
> >>>
> >>>Most states don't have mortality-morbidity review committees; in
> >>>fact, we don't have as many functioning as we did in the 1970s (when
> >>>the maternal mortality rate was still on the decline. That decline
> >>>stopped in 1982, says the CDC.
> >>>
> >>> From the CDC's book "Strategies to Reduce Pregnancy-Related Deaths",
> >>>they write: "There are also specific rules governing coding of causes
> >>>of death that may leave the coder unable to assign a code that
> >>>indicates a relationship to pregnancy. Unfortunately, physicians are
> >> >rarely trained in these rules or in the correct way to complete vital
> >>>records."
> >>>
> >>>For direction in how to do this correctly, go to http://www.cdc.gov/
> >>>nchs/about/major/dvs/handbk.htm
> >>>
> >>> From CDC, Feb. 2007: "In 2003, only four states could capture
> >>>information consistent with the standard." What?????
> >>>
> >>>Anybody want to help me on this quilt I'm making to build awareness
> >>>of this problem? I know that many of you must be good at sewing. I
> >>>already have 16 names for 2007, more than any other year so far (and
> >>>I only get those which appear in the news). The death I heard about
> >>>this morning was a mother of 5 who kept telling her doctor that
> >>>something didn't feel right after her c-section. At autopsy, it was
> >>>found that she died from gangrene, caused by incomplete removal of
> >>>her placenta.
> >>>
> >>>For a sample of stories, anyone who is interested can google these
> >>>names: Tameka McFarquhar, Caroline Wiren, Melissa Farah, Valerie
> >>>Scythes, Galit Schiller, Becky Zalewski, Jasmine Gant, Karen Marie
> >>>Hubbard, Gwyneth Vives, Tatia Oden French, Sabine Elias, Allison
> >>>Lanzet, Jennifer Adams + Tripler Army Base, Julie LeMoult, Inamarie
> >>>Stith-Rouse. Most of these deaths don't fit the stereotype that we've
> >>>been discussing so far here.
> >>>
> >>>Ina May
> >>>
> >>>On Sep 5, 2007, at 5:50 AM, westsidebirthservice@juno.com wrote:
> >>>
> >>>> Ina May--where are you on this discussion? Love to hear your stats
> >>>> given that your understanding is that the maternal mortality rate
> >>>> is largely underreported--did I get that right?
> >>>>
> >>>> Louana
> >>>
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
