Article Abstract:
Although maternal mortality declined dramatically from 1940 to 1980 (from 376 to 9 maternal deaths per 100,000 live births), the death rates for minority women are still more than twice as high as for whites. To understand more about the causes of maternal death, a retrospective study examined all maternal deaths in the US during the years 1979 through 1986. Maternal deaths were those that occurred during pregnancy or within one year afterwards (if related to or aggravated by the pregnancy). Immediate and underlying causes of death were noted and classified. Results showed that 2,644 maternal deaths were reported in the period studied, of which 1,363 occurred after live births; 343 in association with ectopic pregnancies (pregnancies implanted in sites other than the uterus); 263 in association with stillbirths; 124 in association with abortion; and 146 before delivery. The majority of maternal deaths took place during pregnancy or soon after delivery or termination, with fewer occurring at longer intervals after the pregnancy. Overall, the maternal mortality ratio was 9.1 deaths per 100,000 live births, but pronounced differences in rates between minority and white women were seen. Between 1979 and 1986, maternal mortality decreased from 7.1 to 5.1 for white women, and from 27.2 to 16.6 for minority women. Older women had higher death rates than younger women. Unmarried women had an almost threefold-elevated death rate, compared with married women, with marriage reducing the rate more for whites than blacks. The primary causes of death were pulmonary embolism (a clot that lodges in the pulmonary artery), pregnancy-induced hypertension (high blood pressure), hemorrhage, complications of ectopic pregnancy, and infection. A greater proportion of women who died after a live birth had inadequate prenatal care compared with women in the US as a whole (15 versus 5.5 percent). These results indicate that, although decreasing in number, maternal deaths still occur. Their relatively low number has led to the elimination of Maternal Mortality Review Committees in many states, which means no formal mechanism exists for gathering data such as these. Indeed, such a mechanism is needed, if the rate is to be brought even lower. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Tubal pregnancy occurs when a fertilized egg begins to develop inside of the fallopian tube instead of the uterus. This has serious consequences because if it is not diagnosed and treated it can cause the fallopian tube to rupture, and this will reduce the ability to have another pregnancy. Tubal pregnancy can sometimes result in the death of the mother. The traditional treatment for tubal pregnancy has been to surgically remove the affected tube. However, a more conservative approach is being tested. Instead of removing the tube, attempts are being made to surgically remove the fertilized egg from the tube without permanently damaging the tube. It is hoped that this will reduce mortality and preserve fertility. In order to determine how popular this procedure is, data from the National Hospital Discharge Survey, conducted by the Centers for Disease Control, were analyzed. Between 1970 and 1987, 95 percent of all ectopic pregnancies (pregnancies occurring outside of the uterus) were tubal pregnancies. During this period there were 684,914 reported cases of tubal pregnancy. The majority of these cases occurred between 1979 and 1987. During the study period, the use of conservative surgery for treating tubal pregnancy increased from 2 to 12 percent. The average age of women undergoing conservative surgery increased from 24.5 to 27 during the study period. Those who were treated with conservative surgery spent less time in the hospital. In this same period, the use of laparoscopy (a procedure used to for examining the inside of the abdominal and pelvic cavity) for diagnosing tubal pregnancy rose from 10 percent to 33 percent, while the use of diagnostic laparotomy (removal of a tissue sample for examination) decreased from 24 percent to 2 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Women from different minority groups may have a higher risk of placenta previa than white women. Placenta previa is a placenta that develops in the lower portion of the uterus so that it covers or adjoins its opening. A study examined the incidence of placenta previa among women who delivered a live or stillborn infant in the hospital between 1979 and 1987. Approximately 0.5% of the deliveries each year were complicated by placenta previa. Its incidence rose among black women and women from other minority groups, but remained the same among white women. Black women and minority women had a higher risk of placenta previa than white women. Older women also had a higher risk than younger women. Women with placenta previa were more likely to have a cesarean section or to develop abruptio placenta. Abruptio placenta is premature detachment of the placenta.
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