Maternal mortality in New York--Looking back, looking forward.

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.

Framing postpartum hemorrhage as a consequence of human placental biology: an evolutionary and comparative perspective.

Postpartum hemorrhage (PPH), the leading cause of maternal mortality worldwide, is responsible for 35 percent of maternal deaths. Proximately, PPH results from the failure of the placenta to separate from the uterine wall properly, most often because of impairment of uterine muscle contraction. Despite its prevalence and its well-described clinical manifestations, the ultimate causes of PPH are not known and have not been investigated through an evolutionary lens. We argue that vulnerability to PPH stems from the intensely invasive nature of human placentation. The human placenta causes uterine vessels to undergo transformation to provide the developing fetus with a high plane of maternal resources; the degree of this transformation in humans is extensive. We argue that the particularly invasive nature of the human placenta increases the possibility of increased blood loss at parturition. We review evidence suggesting PPH and other placental disorders represent an evolutionarily novel condition in hominins.

[Medicine from the time of industrialization]. / Medizin aus der Gründerzeit.

Last century's "Correspondenzblatt für Schweizer Aerzte" printed clinical observations of four different case-histories. Illustrating the difficulties our predecessors were confronted with, it gives us a picture of their initiatives, their sense of responsibility, and at times of their inability. It explains: The failure of an experiment with an infusion of sodium chloride in the case of a state of shock, a cesarian operation--crowned with success--a case of Fungus haematodes (Schwannoma) in the fossa jugularis and a trepanation performed on a young woman with a serious skull fracture. A special train was made available to take Prof. U. Krönlein from Zurich to Bad Ragaz. The urgent operation took place at night, by candle light in the bathing halls of Bad Pfäfers.