New York City was ahead of its time in recognizing the issue of maternal death and the need for proper statistics. New York has also documented since the 1950s the enormous public health challenge of racial disparities in maternal mortality. This paper addresses the history of the first Safe Motherhood Initiative (SMI), a voluntary program in New York State to review reported cases of maternal deaths in hospitals. Review teams found that timely recognition and intervention in patients with serious morbidity could have prevented many of the deaths reviewed. Unfortunately the program was defunded by New York State. The paper then focuses on the revitalization of the SMI in 2013 to establish three safety bundles across the state to be used in the recognition and treatment of obstetric hemorrhage, severe hypertension in pregnancy, and the prevention of venous thromboembolism; and their introduction into 118 hospitals across the state. The paper concludes with a look to the future of the coordinated efforts needed by various organizations involved in women's healthcare in New York City and State to achieve the goal of a review of all maternal deaths in the state by a multidisciplinary team in a timely manner so that appropriate feedback to the clinical team can be given and care can be modified and improved as needed. It is the authors' opinion that we owe this type of review to the women of New York who entrust their care to us.
Hospitals, Maternity/history , Maternal Health Services/history , Maternal Mortality/history , Patient Care Bundles/history , Female , History, 20th Century , History, 21st Century , Hospitals, Maternity/standards , Humans , Hypertension, Pregnancy-Induced/diagnosis , Hypertension, Pregnancy-Induced/epidemiology , Hypertension, Pregnancy-Induced/history , Hypertension, Pregnancy-Induced/therapy , Maternal Health Services/standards , Maternal Mortality/ethnology , Maternal Mortality/trends , New York/epidemiology , Patient Care Bundles/standards , Patient Safety/history , Patient Safety/standards , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/history , Postpartum Hemorrhage/therapy , Pregnancy , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology , Venous Thromboembolism/history , Venous Thromboembolism/therapy
A doença hipertensiva específica da gestação (DHEH) é uma das causas mais frequentes de morbimortalidade materna e fetal. Apresenta uma incidência de 6-10% nos países desenvolvidos. Este trabalho, que correspondeu a 6,25% de todas as pacientes atendidas na Maternidade da Santa Casa da Misericórdia do Rio de Janeiro, no período de junho de 1994 a junho de 1996, compreendeu o estudo histopatológico de 21 placentas de gestantes com DHEG, com idade média de 26 anos de idade...As lesões vasculares comprovadas pelas técnicas utilizadas, ocasionam hipóxia, a qual desencadeia os eventos fisiopatológicos, responsáveis pelo quadro clínico. A etiopatogenia da DHEG ainda continua desconhecida, tendo como possíveis causas fatores genéticos, endócrinos, metabólicos, imunológicos e biomoleculares. Esses, levariam à hipóxia com sofrimento fetal e materno.
Humans , Extracellular Matrix , Hypertension, Pregnancy-Induced , Hypoxia , Hypertension, Pregnancy-Induced/history , Placenta
