Seminars in Perinatology RSS feed: Current Issue. The purpose of each issue of Seminars in Perinatology is to provide authoritative and comprehensive reviews of a single topic of interest to professionals who care for the mother, the fetus, and the newborn. The journal's readership includes perinatologists, obstetricians, pediatricians, epidemiologists, students in these fields, and others. Each issue offers a comprehensive review of an individual topic, with emphasis on new developments that will have a direct impact on their practice. 2010 Topics , Volume 34, Issues 1-6 February Advances in Neonatal Neuroimaging Catherine Limperopoulos, MD April Newborn Screening Bradford Therrell, Jr, PhD June Neonatal Update William Oh, MD August Consensus Conference on VBAC-Part I Caroline Signore, MD, MPH October Consensus Conference on VBAC-Part II Caroline Signore, MD, MPH December Global Perinatal Health Gary Darmstadt, MD http://www.seminperinat.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Seminars in Perinatology0146-0005361February 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.seminperinat.com/article/PIIS0146000511001893/abstract?rss=yesCover10.1053/S0146-0005(11)00189-3Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-1OFCOFChttp://www.seminperinat.com/article/PIIS014600051100190X/abstract?rss=yesMasthead10.1053/S0146-0005(11)00190-XSeminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-1IFCIFChttp://www.seminperinat.com/article/PIIS0146000511001923/abstract?rss=yesTable of Contents10.1053/S0146-0005(11)00192-3Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-1iihttp://www.seminperinat.com/article/PIIS0146000511001911/abstract?rss=yesTopics10.1053/S0146-0005(11)00191-1Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-1iiiihttp://www.seminperinat.com/article/PIIS0146000511001479/abstract?rss=yesIn 1631, Shah Jahan, emperor during the Mughal Empire's period of greatest prosperity, was grief-stricken when his third wife, Mumtaz Mahal, died during the birth of their 14th child, Gauhara Begum. Construction of the Taj Mahal began in 1632, 1 year after her death. The Shah was so grief-stricken that he built this tomb for his wife's final resting place. There are several messages here, one of which is the Taj Mahal is a “Temple of Love” for a mother who died.IntroductionWashington C. Hill10.1053/j.semperi.2011.09.001Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-111http://www.seminperinat.com/article/PIIS0146000511001480/abstract?rss=yes Although dramatic improvements in pregnancy care and in general population health facilitated a dramatic decline in maternal mortality in the United States during the 20th century, women still die from complications of pregnancy. Moreover, rates appear to have increased during the early 21st century. This overview will provide context for understanding the problem of maternal mortality in the United States by outlining how maternal mortality rates are reported from National Vital Statistics data, and how pregnancy-related mortality ratios are reported from a national surveillance system. Trends and patterns in these deaths as well as emerging issues concerning causes of maternal deaths and the difficulty with interpreting trend data will be discussed. Overview of Maternal Mortality in the United StatesWilliam M. Callaghan10.1053/j.semperi.2011.09.002Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-126http://www.seminperinat.com/article/PIIS0146000511001492/abstract?rss=yes The maternal mortality review process is an ongoing quality improvement cycle with 5 steps: identification of maternal deaths, collection of medical and other data on the events surrounding the death, review and synthesis of the data to identify potentially alterable factors, the development and implementation of interventions to decrease the risk of future deaths, and evaluation of the results. The most important step is utilization of the data to identify and implement evidence-based actions; without this step, the rest of the work will not have an impact. The review committee ideally is based in the health department of a state (or large city) as a core public health function. This provides stability for the process as well as facilitates implementation of the review committees' recommendations. The review committee should be multidisciplinary, with its members being official representatives of their organizations or departments, again to improve buy-in of the stakeholders. From Identification and Review to Action—Maternal Mortality Review in the United StatesCynthia J. Berg10.1053/j.semperi.2011.09.003Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-1713http://www.seminperinat.com/article/PIIS0146000511001509/abstract?rss=yes Following dramatic reductions between the early 1900s and the early 1980s, the maternal mortality ratio began to rise, reaching a peak of almost 17 maternal deaths per 100,000 live births. Although this number pales in comparison with that found in sub-Saharan Africa and India, the troubling rise in the United States is a surrogate for medical care in general and obstetrical care in particular. Both Healthy People 2010 and the United Nations Millennium Goals were aimed at reducing maternal mortality worldwide. This presentation will review the trends in maternal mortality along with the efforts some jurisdictions, along with the American Congress of Obstetricians and Gynecologists, have taken to address this obstetrical tragedy. Although maternal death is the tip of the iceberg, thousands more women suffer a “near-miss” but survive to deal with lifelong medical consequences. Finally, you will be reminded that each maternal death is not just an isolated medical event but rather it permanently affects an ever-enlarging circle of society. Maternal Mortality in the United States - Why Is It Important and What Are We Doing About It?Jeffrey C. King10.1053/j.semperi.2011.09.004Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-11418http://www.seminperinat.com/article/PIIS0146000511001510/abstract?rss=yes The actions that have followed the recommendations of successive publications of the UK Confidential Enquiries into Maternal Deaths have helped save mothers' lives and reduced ill health and morbidity. Through the implementation of their recommendations, they have helped improve access to, and the quality of, the maternity care provided for all pregnant women in the United Kingdom. The enquires help review, assess, and identify the underlying remediable factors that contributed to mothers' deaths and aggregate the lessons learned to make recommendations to develop services that help overcome many of the barriers to safe, high-quality maternity care, which vulnerable women continue to face. This chapter provides a short summary of the positive contributions the successive reports on Confidential Enquiries into Maternal Deaths, “Saving Mothers Lives,” have made to maternal health outcomes in the United Kingdom for more than half a century. It also demonstrates why such systems continue to be beneficial around the world, including countries with very low maternal mortality rates. Saving Mothers' Lives: The Continuing Benefits for Maternal Health From the United Kingdom (UK) Confidential Enquires Into Maternal DeathsGwyneth Lewis10.1053/j.semperi.2011.09.005Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-11926http://www.seminperinat.com/article/PIIS0146000511001522/abstract?rss=yes The maternal–fetal medicine subspecialist plays a critical role in the evaluation and management of women with obstetrical and medical comorbidities. These women have a higher risk for obstetrical morbidity, “near miss,” and maternal mortality. Maternal death surveillance is essential to understand the factors that contribute to maternal mortality. Maternal–fetal medicine subspecialists' involvement and leadership in peer review of maternal deaths can provide guidance in developing and supporting management protocols to the obstetrical community and health care facilities. The Role of the Maternal–Fetal Medicine Subspecialist in Review and Prevention of Maternal DeathsHaywood Brown, Maria Small10.1053/j.semperi.2011.09.006Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-12730http://www.seminperinat.com/article/PIIS0146000511001534/abstract?rss=yes At the beginning of the 20th century, maternal mortality was a leading cause of death for women of reproductive age in the United States. Obstetrical care was not standardized, and there was a lack of universal systems for monitoring maternal deaths. Public health efforts of surveillance, along with advances in medicine and sanitation, resulted in a significant decrease in maternal deaths by the early 1980s. Today, maternal death is considered to be a rare event; however, the rates of maternal mortality have not improved in almost 3 decades. There is growing evidence that many maternal deaths can still be prevented through enhanced surveillance that influences improvements in overall health and delivery of care. This paper describes the experience of establishing and maintaining a pregnancy-associated mortality surveillance system in Florida. Emphasis is placed on the process and importance of a statewide review and the value of engagement with the medical community. Pregnancy-Associated Mortality Review: The Florida ExperienceDeborah Burch, Danielle Noell, Washington C. Hill, Isaac Delke10.1053/j.semperi.2011.09.007Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-13136http://www.seminperinat.com/article/PIIS0146000511001546/abstract?rss=yes Maternal mortality is a current and important issue for obstetrics. The challenge is to structure case reviews so that they develop real data that can inform and direct quality improvement activities. In this article, we describe a series of decisions we have made in California to organize and run our maternal mortality review committee. These include defining the goal of the reviews, selection of cases, composition of the committee, basic review issues, and the definitions used for analysis (eg, cause of death, contributing factors, role of cesarean delivery, preventability, identifying quality improvement opportunities). It is expected that each maternal mortality review committee will have somewhat different approaches based on local resources and case mix. Decisions Required for Operating a Maternal Mortality Review Committee: The California ExperienceElliott K. Main10.1053/j.semperi.2011.09.008Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-13741http://www.seminperinat.com/article/PIIS0146000511001558/abstract?rss=yes The maternal death rate in the United States has shown no improvement in several decades and may be increasing. On the other hand, hospital systems that have instituted comprehensive programs directed at the prevention of maternal mortality have demonstrated rates that are half of the national average. These programs have emphasized the reduction of variability in the provision of care through the use of standard protocols, reliance on checklists instead of memory for critical processes, and an approach to peer review that emphasizes systems change. In addition, elimination of a small number of repetitive errors in the management of hypertension, postpartum hemorrhage, pulmonary embolism, and cardiac disease will contribute significantly to a reduction in maternal mortality. Attention to these general principles and specific error reduction strategies will be of benefit to every practitioner and more importantly to the patients we serve. Strategies for Reducing Maternal MortalitySteven L. Clark10.1053/j.semperi.2011.09.009Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-14247http://www.seminperinat.com/article/PIIS014600051100156X/abstract?rss=yes Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage. Maternal Mortality From HemorrhageSina Haeri, Gary A. Dildy10.1053/j.semperi.2011.09.010Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-14855http://www.seminperinat.com/article/PIIS0146000511001571/abstract?rss=yes Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. During the past 50 years, there has been a significant reduction in the rates of eclampsia, maternal mortality, and maternal morbidity in the developed countries. In contrast, the rates of eclampsia, maternal complications, and maternal mortality remain high in the developing countries. These differences are mainly due to universal access to prenatal care, access to timely care, and proper management of patients with preeclampsia–eclampsia in the developed countries. In contrast, most of maternal deaths and complications are due to lack of prenatal care, lack of access to hospital care, lack of resources, and inappropriate diagnosis and management of patients with preeclampsia–eclampsia in the developing countries. Preeclampsia/eclampsia is associated with substantial maternal complications, both acute and long-term. Clear protocols for early detection and management of hypertension in pregnancy at all levels of health care are required for better maternal as well as perinatal outcome. This is especially important in the developing countries. Maternal Mortality From Preeclampsia/EclampsiaLabib Ghulmiyyah, Baha Sibai10.1053/j.semperi.2011.09.011Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-15659http://www.seminperinat.com/article/PIIS0146000511001583/abstract?rss=yes Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death. Maternal Mortality Due to TraumaVivian Carolina Romero, Mark Pearlman10.1053/j.semperi.2011.09.012Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-16067http://www.seminperinat.com/article/PIIS0146000511001595/abstract?rss=yes Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timely cesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child. Perimortem Cesarean Delivery: Its Role in Maternal MortalityVern L. Katz10.1053/j.semperi.2011.09.013Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-16872http://www.seminperinat.com/article/PIIS0146000511001601/abstract?rss=yes Sudden unexpected changes in the life of a family create many different emotions in various family members. The death of a young woman during or after her pregnancy is especially difficult because of the strain it places on family dynamics. One of the consequences is that there is, commonly, a newborn, and perhaps other children, without a mother and caregiver. In families that relied on both parents working, there are financial hardships imposed by the death. There is the emotional void that is felt by her partner, parents, sisters, brothers, and extended family. This extreme stress leads to questions about the death that need to be addressed by the health care providers. If the anger that is part of the grieving process is not adequately resolved, healing cannot occur. It is then that the family may pursue the legal process to help obtain answers about what happened and, more importantly, why it happened to their loved one. The Medical and Legal Aspects of Maternal MortalityJohn P. Elliott10.1053/j.semperi.2011.09.014Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-17378http://www.seminperinat.com/article/PIIS0146000511001613/abstract?rss=yes A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths. A 6-Year (2004-2009) Review of Maternal Mortality at the Eastern Regional Hospital, Koforidua, GhanaGabriel Y.K. Ganyaglo, Washington C. Hill10.1053/j.semperi.2011.09.015Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-17983http://www.seminperinat.com/article/PIIS0146000511001625/abstract?rss=yes Teamwork, communication, critical incident debriefing, and grief counseling surrounding the events of an unexpected maternal death are important continuing education and practice topics for health care employees working with pregnant women. Social technologies have impacted health care institutions and systems. Ethical dilemmas have been created in hospitals as they develop policies and procedures regarding electronic communications and social networking Web sites. Support and Counseling After Maternal DeathPauline E. Hill10.1053/j.semperi.2011.09.016Seminars in Perinatology 36, 1 (2012)2012-02-01Seminars in Perinatology2012-02-01361S0146-0005(11)X0007-18488