Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
From: art fougner, md (evsono@pipeline.com)
Wed Sep 5 20:00:50 2007
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
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