Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115176

Gina M. Brown, MD, Candace Mulready, MPH, and Deborah L. Kaplan, RPA, MPH. Maternal, Infant and Reproductive Health Program, New York City Department of Health, 2 Lafayette Street, 18th floor, New York, NY 10007, 212-442-1779, gbrown@health.nyc.gov

Background: At 12 deaths/ 100,000 live births (LB) the US pregnancy related mortality (PRM) ratio continues to be greater than the Healthy People 2000 and 2010 goals of 3 deaths/ 100,000 LB. Major causes of death in the US include embolism (20%), hypertensive disorders (17%), and hemorrhage (17%). 55% of US hemorrhage cases occurred in early gestation as ectopic pregnancies (47%) or abortion/miscarriages (8%). Methods: The Bureau of Maternal, Infant, and Reproductive Health in the New York City Department of Health and Mental Hygiene (NYC DOHMH) conducted a review of maternal deaths ascertained between 1998-2000. Results: Late gestation hemorrhage was the most common cause of pregnancy related mortality (32%). 70% of NYC hemorrhage cases occurred as late gestation. This included livebirths, stillbirths, or undelivered cases. Only 23% of NYC hemorrhage cases occurred as ectopic pregnancies (5%) or abortion/ miscarriages (18%). Other causes of PRM in NYC included embolism (7%) and hypertensive disorders (10%). Concomitant obesity increased the odds of hemorrhage related death (OR 3.9, CI 1.8, 8.3). 97% of these women died during hospitalization. Conclusions: Hemorrhage is an important cause of PRM in NYC. Obesity increases the risk of a hemorrhage related death. Next steps: The DOHMH convened a Maternal Mortality Review Committee (MMRC). A letter outlining hemorrhage data was sent to NYC obstetrical care providers. The MMRC and DOHMH will work with care providers and hospitals to develop guidelines for managing obstetrical hemorrhage, conduct hemorrhage drills, and educate clinicians about correct blood loss estimation.

Learning Objectives: Learning Objectives

1 Recognize late gestation hemorrhage as an important cause of maternal mortality
• Discuss policy initiatives to decrease the impact of hemorrhage on maternal mortality

Keywords: Maternal Morbidity, Pregnancy Outcomes

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.