Study: Postpartum period has little surveillance, high rate of maternal deaths

By Deborah Ziff Soriano

The postpartum period has the least surveillance in the pregnancy continuum, yet makes up a disproportionately large portion of in-hospital maternal deaths.

That’s according to a new study based on research conducted at the UIC College of Nursing, which will be published in the print Journal of Nursing Research this month. It is already available online.

The study’s authors say they wanted to look at the timing of in-hospital maternal deaths — before, during and after delivery of a baby — in the hopes that it would shed light on the alarming increase in maternal mortality in recent decades. The U.S. maternal mortality rate increased by 150% between the years of 1987 to 2014, according to the Centers for Disease Control and Prevention — a period when rates went down in most other developed countries.

High rate of postpartum deaths

Postpartum hospitalizations make up only 2% of pregnancy-related hospitalizations, yet account for more than a quarter — or 27.2% — of all in-patient maternal deaths, according to the study. This study defined postpartum hospitalization as any hospitalization within the first 42 days after birth of baby.

“We need to think about how we take care of women after delivery,” said lead author Mulubrhan Mogos, PhD, MSc, who worked on the study as assistant professor of UIC Nursing and is now assistant professor at Vanderbilt University School of Nursing. “After women are discharged, they will [typically] have to wait 6 to 8 weeks to see the doctor. But if you look at the numbers, many women are dying during this period of time, indicating that early supervision of high-risk postpartum women is warranted.”

The study authors include UIC Nursing faculty Barbara McFarlin, Kylea Liese and Patrick Thornton. They reviewed more than 58 million pregnancy-related hospitalizations of women 15 to 49 years old from 2002 to 2014 through the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project.

The study only includes deaths of hospitalized women, and not those who died in emergency rooms or at home.

“This only covers women who were admitted to a hospital,” McFarlin says. “We think maternal mortality in the postpartum period is probably much higher than reported in our study.”

African Americans still at highest risk

African Americans died at significantly higher rates during all periods of pregnancy — before, during and after childbirth (within the first 42 days)— compared with whites and Hispanics, according to the study.

The authors say one glimmer of hope is that maternal in-hospital mortality is decreasing during delivery-related hospitalization. During this period of the pregnancy continuum, in-hospital maternal mortality decreased annually by 3.6% for all women and 4.7% for African Americans. Mogos says this may be due to the close monitoring of women hospitalized for childbirth and the availability of anesthesia service in case of an emergency that requires surgical intervention.

However, even during hospitalization for childbirth, African-American women are still three times more likely to die than white women.

The study also found that women who died while hospitalized had higher rates of “severe maternal morbidity,” meaning three or more severe conditions were present. The most common comorbidity among women who die during pregnancy-related hospitalization was acute myocardial infarction, or heart attack.

McFarlin says the study speaks to the need for more “personalized” prenatal care and education to help women recognize warning signs.

“We have been looking at a formula for prenatal and postpartum care, rather than looking at the person and what they need,” she says.