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1.
Circulation ; 144(15): e251-e269, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34493059

RESUMO

The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in advancing maternal and reproductive health equity in the United States. There have been significant strides in improving the timeliness of data reporting in maternal mortality surveillance and epidemiological programs in maternal and child health, yet more policy reforms are necessary. To make a sustainable and systemic impact on maternal health, further efforts are necessary at the societal, institutional, stakeholder, and regulatory levels to address the racial and ethnic disparities in maternal health, to effectively reduce inequities in care, and to mitigate maternal morbidity and mortality. In alignment with American Heart Association's mission "to be a relentless force for longer, healthier lives," this policy statement outlines the inequities that influence disparities in maternal outcomes and current policy approaches to improving maternal health and suggests additional potentially impactful actions to improve maternal outcomes and ultimately save mothers' lives.

2.
JAMA Netw Open ; 4(8): e2120456, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34379123

RESUMO

Importance: Prior studies on COVID-19 and pregnancy have reported higher rates of cesarean delivery and preterm birth and increased morbidity and mortality. Additional data encompassing a longer time period are needed. Objective: To examine characteristics and outcomes of a large US cohort of women who underwent childbirth with vs without COVID-19. Design, Setting, and Participants: This cohort study compared characteristics and outcomes of women (age ≥18 years) who underwent childbirth with vs without COVID-19 between March 1, 2020, and February 28, 2021, at 499 US academic medical centers or community affiliates. Follow-up was limited to in-hospital course and discharge destination. Childbirth was defined by clinical classification software procedural codes of 134-137. A diagnosis of COVID-19 was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of U07.1. Data were analyzed from April 1 to April 30, 2021. Exposures: The presence of a COVID-19 diagnosis using ICD-10. Main Outcomes and Measures: Analyses compared demographic characteristics, gestational age, and comorbidities. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, mechanical ventilation, and discharge status. Continuous variables were analyzed using t test, and categorical variables were analyzed using χ2. Results: Among 869 079 women, 18 715 (2.2%) had COVID-19, and 850 364 (97.8%) did not. Most women were aged 18 to 30 years (11 550 women with COVID-19 [61.7%]; 447 534 women without COVID-19 [52.6%]) and were White (8060 White women [43.1%] in the COVID-19 cohort; 499 501 White women (58.7%) in the non-COVID-19 cohort). There was no significant increase in cesarean delivery among women with COVID-19 (6088 women [32.5%] vs 273 810 women [32.3%]; P = .57). Women with COVID-19 were more likely to have preterm birth (3072 women [16.4%] vs 97 967 women [11.5%]; P < .001). Women giving birth with COVID-19, compared with women without COVID-19, had significantly higher rates of ICU admission (977 women [5.2%] vs 7943 women [0.9%]; odds ratio [OR], 5.84 [95% CI, 5.46-6.25]; P < .001), respiratory intubation and mechanical ventilation (275 women [1.5%] vs 884 women [0.1%]; OR, 14.33 [95% CI, 12.50-16.42]; P < .001), and in-hospital mortality (24 women [0.1%] vs 71 [<0.01%]; OR, 15.38 [95% CI, 9.68-24.43]; P < .001). Conclusions and Relevance: This retrospective cohort study found that women with COVID-19 giving birth had higher rates of mortality, intubation, ICU admission, and preterm birth than women without COVID-19.


Assuntos
COVID-19/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adolescente , Adulto , COVID-19/terapia , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/terapia , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos/epidemiologia , Adulto Jovem
3.
Clin Obstet Gynecol ; 63(4): 808-814, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33060374

RESUMO

Cardiovascular disease (CVD) has surpassed the traditional causes of pregnancy-related mortality, including hemorrhage and thromboembolism in the United States. CVD accounts for ~15.5% of all pregnancy-related deaths. Pregnancy is a "natural cardiovascular stress test" for a woman. The physiological changes in the maternal hemodynamics that are geared to accommodate the growing needs of the fetal-placental unit may also lead to symptoms that are indistinguishable from those of CVD, especially in the third trimester of pregnancy. It is imperative that an obstetric provider is able to differentiate symptoms of normal pregnancy from those of a pathologic process.

4.
Am J Obstet Gynecol ; 223(5): B2-B5, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32861689

RESUMO

Pregnancy in women with pregestational diabetes mellitus (type 1 and type 2) carries increased risks of both maternal and neonatal complications due to maternal hyperglycemia and underlying chronic conditions and comorbidities. To reduce the risk of pregnancy complications or to mitigate their effects, numerous interventions are recommended at various times during pregnancy. Since 2016, the Society for Maternal-Fetal Medicine has posted a Diabetes Antepartum Checklist on its website. An updated version of this checklist is presented here, along with suggestions for implementation into the standard antenatal care of patients with type 1 and type 2 diabetes mellitus.


Assuntos
Lista de Checagem , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Gravidez em Diabéticas/terapia , Cuidado Pré-Natal/métodos , Aspirina/administração & dosagem , Parto Obstétrico , Gerenciamento Clínico , Feminino , Humanos , Educação de Pacientes como Assunto , Inibidores da Agregação Plaquetária/administração & dosagem , Gravidez , Ultrassonografia Pré-Natal
6.
Am J Perinatol ; 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32512606

RESUMO

OBJECTIVE: The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy. STUDY DESIGN: This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities. RESULTS: The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01-1.74) for women with overweight BMI and 2.03 (95% CI: 1.57-2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95-1.66) for overweight women and 1.38 (95% CI: 1.04-1.84) for women with obesity. The ORs suggested a dose-response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00. CONCLUSION: Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period. KEY POINTS: · Pre-pregnancy obesity affects maternal health.. · Effects may extend to peripartum cardiomyopathy.. · The risk includes peripartum cardiomyopathy that emerges postpartum..

7.
Am J Obstet Gynecol ; 223(1): B2-B15, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32272091

RESUMO

There are many organizations in the United States concerned with the improvement of patient safety and healthcare quality. In this overview, we provide a synopsis of the major entities whose work is relevant to maternal healthcare. For each organization, we summarize its mission, vision, major programs, and relationships with other entities. We include 13 entities with broad scope covering all types of healthcare; 9 organizations whose focus is maternal-child health; 6 women's health professional organizations with committees on patient safety, quality, or both; 12 organizations that offer accreditation, certification, or special distinction based on quality; and 5 organizations that rate, rank, or report quality metrics.


Assuntos
Serviços de Saúde Materna/normas , Organizações , Segurança do Paciente , Qualidade da Assistência à Saúde , Humanos , Agências Internacionais , Estados Unidos
8.
Am J Obstet Gynecol ; 222(6): B2-B9, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32114082

RESUMO

Congenital heart defects are a leading cause of neonatal morbidity and mortality. Accurate prenatal diagnosis of congenital heart defects can reduce morbidity and mortality by improving prenatal care, facilitating predelivery pediatric cardiology consultation, and directing delivery to facilities with resources to manage the complex medical and surgical needs of newborns with congenital heart defects. Unfortunately, less than one half of congenital heart defect cases are detected prenatally, resulting in lost opportunities for counseling, shared decision-making, and delivery at an appropriate facility. Quality improvement initiatives to improve prenatal congenital heart defects detection depend on the ability to measure the rate of detection at the level of providers, facilities, or populations, but no standard metric exists for measuring the detection of congenital heart defects at any level. The need for such a metric was recognized at a Cooperative Workshop held at the 2016 Annual Meeting of the Society for Maternal-Fetal Medicine, which recommended the development of a quality metric to assess the rate of prenatal detection of clinically significant congenital heart defects. In this paper, we propose potential quality metrics to measure prenatal detection of critical congenital heart defects, defined as defects with a high rate of morbidity or mortality or that require surgery or tertiary follow-up. One metric is based on a retrospective approach, assessing whether postnatally diagnosed congenital heart defects had been identified prenatally. Other metrics are based on a prospective approach, assessing the sensitivity and specificity of prenatal diagnosis of congenital heart defects by comparing prenatal ultrasound findings with newborn findings. Potential applications, limitations, challenges, barriers, and value for both approaches are discussed. We conclude that future development of these metrics will depend on an expansion of the International Classification of Diseases system to include specific codes that distinguish fetal congenital heart defects from newborn congenital heart defects and on the development of record systems that facilitate the linkage of fetal records (in the maternal chart) with newborn records.


Assuntos
Coração Fetal/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Indicadores de Qualidade em Assistência à Saúde , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal
9.
Obstet Gynecol ; 134(4): 882, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568353
10.
AJP Rep ; 9(3): e256-e261, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31435486

RESUMO

Background Pregnant women with Marfan syndrome (MFS) are known to be at increased risk of aortic dissection; however, cases of aortic rupture are extremely rare. There is lack of consensus on the exact site and size of aortic diameter measurement that increases this risk, and whether this applies to both Type A and Type B dissections. Case A 23-year-old G2P1001 with known Marfan syndrome who underwent an uncomplicated antepartum and intrapartum course. She experienced persistent backache 10 days postpartum that led to the diagnosis of Stanford Type B dissection. The patient was hospitalized for close observation. Dissection progressed to aortic rupture within 24 hours that required emergent thoracic endovascular aortic repair. She had an uncomplicated postoperative course. Conclusion Our report demonstrates rupture of a known aortic dissection within a very short time in the postpartum period. The case highlights the importance of patient education and close surveillance especially in the postpartum period. It also brings home the value of imaging of the whole aorta rather than focusing on the ascending alone. Multidisciplinary care and timely diagnosis and intervention likely led to the favorable outcome in our case.

11.
Obstet Gynecol Clin North Am ; 46(3): 515-525, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378292

RESUMO

The authors' goal is to review the current recommendations for optimizing cardiovascular health beginning in adolescent years to adulthood, and to expand on the role that pregnancy complications may have as implications for future cardiovascular health. Attention to cardiac health begins in adolescence; however, most young patients are not screened. Pregnancy, with its increased cardiovascular demands and host of antepartum cardiopulmonary complications, may provide a window into future cardiac health. The distinct shift in cardiac risk that occurs once a woman enters menopause is largely ignored in routine screening guidelines.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Saúde da Mulher , Adolescente , Adulto , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Programas de Rastreamento , Menopausa , Pessoa de Meia-Idade , Pós-Menopausa , Pré-Eclâmpsia , Gravidez , Complicações na Gravidez , Fatores de Risco , Adulto Jovem
12.
Am J Obstet Gynecol ; 221(1): 1-8, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30682360

RESUMO

Deaths related to pregnancy were relatively common in the United States at the beginning of the twentieth century. A dramatic reduction of 99% in maternal mortality rate, from 850.0-7.5 per 100,000 live births from 1900-1982, is 1 of the most noteworthy public health success stories of the time period. This plateau continued until the late 1990s when the maternal mortality rate began to rise again. The reasons for this increase are unclear. Vital statistics data alone cannot answer the many questions surrounding this increase. The need for detailed and reliable information about causes of death and underlying factors has led to the development of state- and urban-based maternal death reviews. Although processes may vary, an expert panel is convened to review individual cases and make recommendations for systems change. Review of maternal deaths is considered to be a core public health function. There are multiple purposes for this article. The first goal is to highlight the components of a maternal mortality review. The second goal is to provide an example for new review committees. A mock case of cardiomyopathy is used to illustrate both the process and development of actionable recommendations for clinical intervention. Recommendations to address community- and system-level contributing factors and the social determinants of health are discussed. The third goal is to educate providers regarding presentation and management of cardiomyopathy. Fourth, it is hoped that policymakers in the area of maternal health and facilities that review maternal morbidity and mortality rates at the institutional level will find the article useful as well. Finally, the article provides facility-level committees with a process example for review of the circumstances of maternal deaths beyond clinical factors so that they may make recommendations to address nonclinical contributors to pregnancy-related deaths. Documenting both clinical and nonclinical contributors to maternal death are critical to influence public opinion, develop coalitions for collective impact, and engage at risk populations in proposing interventions.


Assuntos
Comitês Consultivos , Morte Materna , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Transtornos Puerperais/mortalidade , Choque Cardiogênico/mortalidade , Determinantes Sociais da Saúde , Adulto , Cardiomiopatias/epidemiologia , Causas de Morte , Consenso , Serviço Hospitalar de Emergência , Prova Pericial , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Mortalidade Materna , Gravidez , Qualidade da Assistência à Saúde , Fatores de Risco
13.
Am J Obstet Gynecol ; 220(2): 167.e1-167.e8, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30278179

RESUMO

Cardiac disease in pregnancy is the number one indirect cause of maternal mortality in the United States. We propose a triad solution that includes universal screening for cardiovascular disease in pregnancy and postpartum women, patient education, and institution of a multidisciplinary cardiac team. Additionally, we emphasize essential elements to maximize care for the pregnant cardiac patient based on our experience at our institution in Bronx, NY.


Assuntos
Cardiopatias/mortalidade , Mortalidade Materna , Assistência Perinatal/métodos , Complicações na Gravidez/mortalidade , Feminino , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Fatores de Risco , Estados Unidos/epidemiologia
14.
AJP Rep ; 8(4): e335-e342, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30473907

RESUMO

Objective This study is to review published cases of peripartum cardiomyopathy (PPCM) treated with bromocriptine and outline pros and cons of the treatment strategy. Data Sources Data were collected from PubMed/MedLine, ClinicalTrials.gov; the years 2007 to 2018 were searched for English-language articles. Search terms: "bromocriptine and peripartum cardiomyopathy", "bromocriptine and cardiomyopathy." Methods of Study Selection This search strategy yielded 171 articles. After excluding duplicates, 86 studies were reviewed. Sixty-one articles involving the treatment of PPCMP were included, and of these, 17 were case reports of patients with PPCMP treated with bromocriptine; these studies were included in this review. Tabulation, Integration, and Results Seventeen of these articles were case reports of patients with peripartum cardiomyopathy treated with bromocriptine that were included. Conclusion Bromocriptine seems to be a promising treatment, there is currently insufficient evidence for universal utilization of bromocriptine for all patients with PPCMP. Addition of bromocriptine to the standard heart failure therapy should be individualized.

15.
Curr Hypertens Rev ; 13(2): 80-88, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28554307

RESUMO

BACKGROUND: Hypertensive disorders (preeclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia) complicate 3-5% of all pregnancies and are a significant cause of maternal mortality and morbidity. Preeclampsia is a multi-system disorder characterised by new onset hypertension after the 20th week of pregnancy with proteinuria. Proteinuria is defined as 300 mg or more of protein in a 24-hour urine collection or a protein: creatinine ratio of 0.3 mg/dL using a spot urine specimen. Hypertensive disorders have a complex pathophysiology that results from abnormal placen- tation and a maternal response that develops into a clinicalsyndrome for which there is no single test or "cure". In high income countries, low rates of maternal mortality from hy- pertensive disease in pregnancy illustrate the importance of pregnant women being able to readily access antenatal care. CONCLUSION: There remains the need to develop evidence-based clinical guidelines for detection, prophylaxis and management worldwide.


Assuntos
Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Pressão Sanguínea/efeitos dos fármacos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Eclampsia/diagnóstico , Eclampsia/tratamento farmacológico , Eclampsia/fisiopatologia , Feminino , Síndrome HELLP/diagnóstico , Síndrome HELLP/tratamento farmacológico , Síndrome HELLP/fisiopatologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/fisiopatologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Proteinúria/diagnóstico , Fatores de Risco , Resultado do Tratamento , Urinálise
17.
J Obstet Gynecol Neonatal Nurs ; 45(5): 706-17, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27619099

RESUMO

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Assuntos
Mortalidade Materna , Tromboembolia Venosa , Consenso , Feminino , Humanos , Morte Materna , Guias de Prática Clínica como Assunto , Gravidez , Fatores de Risco
18.
Obstet Gynecol ; 128(4): 688-98, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27607857

RESUMO

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Assuntos
Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/efeitos adversos , Cesárea , Consenso , Feminino , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Parto , Período Periparto , Guias de Prática Clínica como Assunto , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Medição de Risco , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico , Fatores de Tempo , Tromboembolia Venosa/epidemiologia
19.
Anesth Analg ; 123(4): 942-9, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27636577

RESUMO

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Assuntos
Morte Materna/prevenção & controle , Segurança do Paciente , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/prevenção & controle , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Humanos , Mortalidade Materna/tendências , Segurança do Paciente/normas , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Complicações na Gravidez/diagnóstico , Fatores de Risco , Estados Unidos/epidemiologia , Tromboembolia Venosa/diagnóstico
20.
J Midwifery Womens Health ; 61(5): 649-657, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-29473681

RESUMO

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into 4 domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Assuntos
Morte Materna , Complicações na Gravidez/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Consenso , Feminino , Humanos , Mortalidade Materna , Segurança do Paciente , Gravidez , Complicações na Gravidez/etiologia , Fatores de Risco , Tromboembolia Venosa/etiologia
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