Abstract:
BACKGROUND:Pregnancy-related deaths in the United States are increasing. Medical, social, economic, and cultural issues have all been implicated in this trend, but few data exist to differentiate the relative contributions of these various factors. OBJECTIVE:The objective of the study was to examine trends in US pregnancy-related mortality by place of death and maternal race and age. We hypothesized that such an analysis may allow some distinction between deaths related to medical performance and those more closely related to social, cultural, or environmental issues. STUDY DESIGN:We conducted a retrospective, cross-sectional study for the years 2003-2016 using multiple cause-of-death mortality data provided by the Centers for Disease Control and Natality Data provided by National Vital Statistics System of the National Center for Health Statistics. Temporal trends analyses for the place of death, race/ethnicity, and age at the time of death were performed using joinpoint regression over the study period. RESULTS:Approximately one third of pregnancy-related deaths occurred outside a medical facility. The fraction of maternal deaths occurring in inpatient facilities fell by 20% over the study period, from 53% to 44% of all maternal deaths (P < .0001). Maternal deaths in an outpatient facility or emergency room demonstrated a similar decline (24%) in relative frequency (P < .0001). In contrast, there was a significant increase in the relative frequency of maternal mortality in other settings, particularly within the descendant's home, with a doubling over this time period. However, overall pregnancy-related deaths continued to increase in all settings. These increases were particularly striking in non-Hispanic black and white women and among women in the youngest and oldest age groups. CONCLUSION:Against a background of rising US pregnancy-related mortality, stratification of such deaths by place of death and maternal age and race highlights both the need for ongoing improvements in the quality of medical care and the potential contribution of events occurring outside a medical facility to the overall morality ratio. Current trends in pregnancy-related mortality in the United States are, in part, driven by social, cultural, and financial issues beyond the direct control of the medical community.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Burgess APH,Dongarwar D,Spigel Z,Salihu HM,Moaddab A,Clark SL,Fox Kdoi
10.1016/j.ajog.2020.02.020subject
Has Abstractpub_date
2020-05-01 00:00:00pages
489.e1-489.e8issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(20)30208-8journal_volume
222pub_type
杂志文章abstract:OBJECTIVE:The objective of the study was to assess the prevalence of levator ani denervation and reinnervation 6 months after the first delivery. STUDY DESIGN:Ninety-six primigravida women underwent quantitative electromyography of the levator ani during the third trimester and twice postpartum. A 95% confidence inter...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.12.044
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the effect of in utero exposure to indomethacin on the need for surgical closure of a patent ductus arteriosus (PDA). STUDY DESIGN:Perinatal variables were compared between infants at <32 weeks who required surgical closure of PDA after failed medical management and those who did...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.127464
更新日期:2002-10-01 00:00:00
abstract::We have extended our evaluation of the effects of three beta-adrenergic agents in near-term pregnant sheep to include a period of infusion three times longer than previously studied. This extension has provided the following information: (1) Initial depression of uterine blood flow and mean arterial pressure associate...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90708-6
更新日期:1977-08-01 00:00:00
abstract::The rates of regression of human chorionic gonadotropin (hCG) in patients with complete hydatidiform moles, partial hydatidiform moles, and nonmolar abortions were compared. No difference in rates of regression was found among the three groups, but levels of hCG immediately after uterine evacuation were significantly ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90184-4
更新日期:1984-05-15 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the effects of recombinant human relaxin on the uterine artery and myometrial contractility in pregnant rats. STUDY DESIGN:Uterine artery and myometrial rings from mid and term pregnant rats were used. Relaxin effect was studied on phenylephrine-induced contraction i...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.454
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:Our purpose was to evaluate the outcome of infants who underwent successful resuscitation after initial Apgar scores of 0 at both 1 and 5 minutes. STUDY DESIGN:Eligible infants were identified through the perinatal database at the University of Tennessee, Memphis. Hospital records and long-term outcomes, whe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.104951
更新日期:2000-05-01 00:00:00
abstract::A woman pregnant with her second child was given sulfisoxazole (Gantrisin) during her eighth month of pregnancy for a urinary tract infection. Her 34-week-old male infant was stillborn with hydrops fetalis and severe anemia. The mother was found to be glucose-6-phosphate-dehydrogenase (G-6-PDH) deficient. Ingestion...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(71)90781-2
更新日期:1971-10-01 00:00:00
abstract:OBJECTIVE:The objectives of the investigation were to study the association between levator hiatus dimensions in late pregnancy and both the length of second stage of labor and also the delivery mode in women delivering their first child. STUDY DESIGN:In this cohort study, 231 nulliparous women were examined with 3- a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2014.02.021
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:The purpose of our study was to determine whether maternal vitamin K1 administered antenatally improved global coagulation parameters and the levels of specific vitamin K-dependent proteins in low-birth-weight infants. STUDY DESIGN:Thirty-three preterm mothers admitted in labor were assigned in a prospective...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9378(94)70389-2
更新日期:1994-01-01 00:00:00
abstract::Prenatal diagnosis of Jarcho-Levin syndrome early in pregnancy has not been previously reported. We present a case in which ultrasound examination resulted in a tentative diagnosis at 22 weeks of pregnancy. The difficulties in arriving at a definite diagnosis are presented. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90354-1
更新日期:1987-04-01 00:00:00
abstract::Oral contraceptives are combinations of estrogens and progestogens or, in the case of the mini-pills, progestogens alone. With specific test procedures in laboratory animals or human subjects, it is possible to assign potency evaluations to the components relative to the progestational, estrogenic, or antiestrogenic a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90804-8
更新日期:1976-08-15 00:00:00
abstract:BACKGROUND:The American Heart Association's formal characterization of cardiovascular health combines several metrics in a health-oriented, rather than disease-oriented, framework. Although cardiovascular health assessment during pregnancy has been recommended, its significance for pregnancy outcomes is unknown. OBJEC...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.07.053
更新日期:2020-08-05 00:00:00
abstract::As a corollary to a case-control study evaluating the risk of pelvic inflammatory disease (PID) among users of an intrauterine contraceptive device (IUD), Papanicolaou smears were studied to detect the presence of actinomycetes. Forty-six PID case patients and 108 control patients were included in the corollary study....
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90552-x
更新日期:1982-07-01 00:00:00
abstract:BACKGROUND:Several articles have implied that progestogen supplementation during pregnancy to reduce the risk of preterm birth may increase the risk for developing gestational diabetes mellitus. OBJECTIVE:The purpose of the present meta-analysis was to accumulate existing evidence concerning this correlation. DATA SO...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1016/j.ajog.2019.05.033
更新日期:2019-11-01 00:00:00
abstract::Intrapartum fetal heart rate and subcutaneous scalp PO2 were continuously measured with a combined electrocardiogram-PO2 needle electrode in 34 patients. The incidence of fetal heart rate abnormalities increased significantly with decreasing subcutaneous PO2, from 0.8% of the 10-minute periods in which subcutaneous PO...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90476-4
更新日期:1985-11-01 00:00:00
abstract::A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the plac...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90514-r
更新日期:1991-03-01 00:00:00
abstract::Ferning of amniotic fluid was studied in early pregnancy. Arborization was demonstrated during the interval of 6 1/2 to 16 weeks by flame-drying. Air-drying yielded a spectrum of crystallization from none prior to 8 weeks to full ferning by 16 weeks. Technical differences are stressed. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90617-4
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVE:Our purpose was to assess whether a program of expectant management of uncomplicated pregnancies in mothers with insulin-requiring gestational or pregestational class B reduces the incidence of cesarean birth. STUDY DESIGN:Two hundred women with uncomplicated, insulin-requiring diabetes at 38 weeks' gestatio...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(93)90631-r
更新日期:1993-09-01 00:00:00
abstract:OBJECTIVE:Women with chronic hypertension are at increased risk for superimposed preeclampsia. We developed a prediction algorithm for superimposed preeclampsia using clinical and laboratory information that were measured early in pregnancy. STUDY DESIGN:A secondary analysis of data that were collected from 110 women ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.03.029
更新日期:2004-11-01 00:00:00
abstract::Fetal heart rate (FHR) is influenced by the central nervous system, cardiac automatism, biochemical factors, etc. Changes in FHR were correlated with the anatomic defect in autopsy material from 20 anencephalic infants, and, on this basis, the following hypotheses were formed, subject to later experimental proof. (1) ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90199-6
更新日期:1984-05-15 00:00:00
abstract:OBJECTIVE:This study was undertaken to evaluate the effects on peripheric pulmonary vessel muscularization by tracheal occlusion (TO) performed at different gestational ages in fetal rabbits with surgically induced diaphragmatic hernia. STUDY DESIGN:In 23 New Zealand white does, both ovarian end fetuses underwent surg...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.01.006
更新日期:2004-09-01 00:00:00
abstract::Peritoneal fluid from women with endometriosis, unexplained infertility, and fertile controls were compared to one another and to normal human serum for effects on lymphocyte proliferation in vitro. Peritoneal fluid samples were also assayed for both interleukin-1 and interleukin-2. All peritoneal fluid samples signif...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90736-9
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine if the success and safety of vaginal birth after cesarean delivery in a small, isolated, rural hospital compare with those seen in larger centers. STUDY DESIGN:As part of a continuing study, the prenatal and hospital records of all patients with previous cesarean de...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(12)90885-6
更新日期:1993-01-01 00:00:00
abstract::Despite intense study preeclampsia remains enigmatic and a major cause of maternal and fetal morbidity and mortality. Most investigative efforts have focused on the hypertensive component of this disorder with reduced attention given to other equally important characteristics. Increased sensitivity to pressor agents a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90665-0
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:The purposes of this study were to examine endothelial nitric oxide synthase expression in endothelial cells and to determine whether the inhibition of endothelial nitric oxide synthase could impair endothelial barrier function in preeclampsia. STUDY DESIGN:Messenger RNA and protein expression for endothelia...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2003.09.049
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:We sought to develop a valid, reliable assessment of intraoperative judgment by residents during gynecologic surgery based on Script Concordance Theory. STUDY DESIGN:This was a multicenter prospective study involving 5 obstetrics and gynecology residency programs. Surgeons from each site generated case scena...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2010.04.010
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine amniotic fluid volume by the dye-dilution technique and compare it with the amniotic fluid index, largest vertical pocket, and two-diameter pocket (defined as vertical x horizontal of the largest vertical pocket). STUDY DESIGN:This prospective study involved 40 women undergoing a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91734-r
更新日期:1992-12-01 00:00:00
abstract::Clearance indices (clearance of experimental material: clearance of antipyrine, CI) across the perfused human placenta were determined for urea, sodium, and chloride. The selected materials are of relatively small molecular weight and are water soluble. Clearance of urea was determined under conditions of net transfer...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(15)33310-x
更新日期:1981-11-15 00:00:00
abstract::Much has been written about the need for help for the overworked obstetrician. Two obstetricians delivering over 500 babies annuallay had insufficient time for their gynecology practice. Two nurse-midwives were employed and in the first year they delivered 61 per cent of those patients who delivered vaginally. All nor...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(75)90940-0
更新日期:1975-09-01 00:00:00
abstract::Primary cesarean sections were performed on 395 patients between January 1, and December 31, 1976. A retrospective review of 322 of these patients indicated that the incidence of postoperative intrauterine infection was the same in both monitored and nonmonitored patients. The incidence of postoperative intrauterine i...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90597-9
更新日期:1980-01-15 00:00:00