Maternal Mortality 2018: A Call to Action Donald J. Dudley, M.D. Department of Obstetrics and Gynecology University of Virginia

Disclosures I have no relevant disclosures.

A Historical and Cultural Perspective

Genesis 35:17-20 When her pangs were most severe, her midwife said to her, “Have no fear! This time, too, you have a son”. With her last breath—for she was at the point of death—she called him Ben-oni; his father, however, named him Benjamin. Thus Rachel died; and she was buried on the road to Ephrath [that is, Bethlehem]. Jacob set up a a memorial stone on her grave, and the same monument marks Rachel’s grave to this day.

Shah Jahan Mumtaz Mahal

Martha Wayles Skelton Jefferson Died September 6, 1782 Mary “Polly” Jefferson Eppes Died April 17, 1804 Anne Randolph Bankhead Died February 11, 1826

Padme Amidala

Tom Riddle, son of Merope Gaunt

But Why the Increase? The Causes of Maternal Death

Reasons for the Increase Ascertainment Complexities Delayed Childbearing Obesity Epidemic Increase in Cesarean Deliveries Severity of Maternal Medical Conditions Sem Perinatol 2012;36:14-18

In Maryland from 1993-2000 (n=129), 38% of Maternal Deaths are Not Reported on Death Certificates

Reasons for the Increase Ascertainment Complexities Delayed Childbearing Obesity Epidemic Increase in Cesarean Deliveries Severity of Maternal Medical Conditions Sem Perinatol 2012;36:14-18

Reasons for the Increase Ascertainment Complexities Delayed Childbearing Obesity Epidemic Increase in Cesarean Deliveries Severity of Maternal Medical Conditions Sem Perinatol 2012;36:14-18

Obesity and Maternal Death Louis, et al. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep 2014;37:843-849. Nationwide Inpatient Sample database 55 million hospital discharges OSA related to Increased Odds: Preeclampsia: 2.5 (2.2-2.9) Eclampsia: 5.4 (3.3-8.9) Cardiomyopathy: 9.0 (7.5-10.9) Pulmonary Embolism: 4.5 (2.3-8.9) In-hospital Mortality: 5 (2.4-11.5)

Reasons for the Increase Ascertainment Complexities Delayed Childbearing Obesity Epidemic Increase in Cesarean Deliveries Unmasking of Maternal Medical Conditions Sem Perinatol 2012;36:14-18

Clark, et al. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008;199:e1-36.

Reasons for the Increase Ascertainment Complexities Delayed Childbearing Obesity Epidemic Increase in Cesarean Deliveries Severity of Maternal Medical Conditions Sem Perinatol 2012;36:14-18

Hospitalization for Severe Maternal Morbidity: USA 1988-2011 Creanga, et al. Maternal Mortality in the United States: Where are We Now? J Women’s Health 2014;23:3-9.

Prevention of Maternal Death Systems-Based Approaches Individual Measures

Maternal Mortality Review Berg C. From identification to review to action—maternal mortality review in the United States. Sem Perinatol 2012;36:7-13

History of Maternal Mortality Review in the USA Marmol, et al. History of the Maternal Mortality Study Committees In the United States. Obstet Gynecol 1969;34:123-138

Maternal Mortality Review Main E. Decisions required for operating a maternal mortality review committee: the California experience. Sem Perinatol 2012:36:37-41