Severe complications increase sharply in women giving birth in hospitals

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According to a report published by the Agency for Research and Quality of Health Care (AHRQ), the proportion of women who had severe complications during delivery in US hospitals increased by 45% between 2006 and 2015. More worryingly, the data show remaining for low-income women and minorities – especially black women and those under Medicaid.

The Centers for Disease Control and Prevention (CDC) suggest that some of the increased complications are due to general changes in the US population. For example, the increase in the mother's age, pre-existing medical conditions, and obesity before pregnancy are cited as underlying factors associated with maternal morbidity and mortality. But they can not explain all the disturbing increases described by the AHRQ. More specifically, during the decade of analysis, the report states that rates of sepsis at delivery, acute renal failure and shock more than doubled.

The purpose of the AHRQ's Health Care Cost and Utilization Project was to explore "overall patterns of serious maternal morbidity and mortality while identifying areas of particular concern". But the results should serve as a warning to the country's health system and clearly note the need for hospitals to better integrate teamwork and training strategies into safety culture in labor and delivery.

Although the report provides many detailed statistics on the complications of labor and delivery, here are some of the most important examples (ranging from racial and geographical variation to the probability of complications depending on age):

• The rate of serious complications increased from 101 per 10,000 hospitalizations in 2006 to 147 per 10,000 in 2015 ( Overall increase of 45% ).
• While deaths declined for all races / ethnic groups, hospital mortality was 3 times higher for black women than for white women in 2015 (11 vs. 4 per 100,000 deliveries).
• On average, black mothers were younger than white mothers. But the rate of severe maternal morbidity was between 112 and 115% higher among blacks than whites in 2006 (164 against 76) and in 2015 (241 against 114). This highlights that there has been no change in black-white disparities .
• Hispanics and Asians / Pacific Islanders also had higher rates of serious maternal morbidity than Whites in both years, but disparities decreased over time.
• Serious maternal morbidity was highest among women aged 40 and over and lowest among women aged 20 to 29 (248 and 136 per 10,000 births, respectively). But the under-20s also had more complications than their peers from 20 to 29 years old.
• Some serious conditions involve medical procedures. In 2015, for example, more than half of all deliveries occurred in mothers with shock, amniotic embolism, sickle cell crisis or blood clots throughout the body. 1/3 of the shock deliveries had a hysterectomy.
• In 2015, severe maternal morbidity rates were highest among poor, uninsured or Medicaid mothers, and lived in large urban areas. .
• Compared with deliveries that did not have serious maternal morbidity, those who did were more likely to visit hospitals with a mission to serve vulnerable populations (44% versus 35%), serving minorities (53% vs. 44%). . , teaching (71% vs. 67%) and public hospitals (16% vs. 12%).
• Serious maternal morbidity was also more likely to occur in hospitals in the north-east (18% versus 16%) and in southern hospitals (44% versus 40%) than in Midwestern hospitals (17%). 21%). West (21% vs. 23%).

In order to help hospitals reduce serious maternal morbidity, AHRQ has developed the Perinatal Care Safety Program with the goal of improving communication between hospital staff and overall quality. care in the labor and delivery units. The recommendations are based on a large amount of data and documents from other programs and training systems. With this data in hand, state and federal agencies, patient safety experts and health systems should further assess trends in maternal morbidity, and then commit to taking immediate steps to increase efforts. protection of mothers and children.

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According to a report published by the Agency for Research and Quality of Health Care (AHRQ), the proportion of women who had severe complications during delivery in US hospitals increased by 45% between 2006 and 2015. More worryingly, the data show remaining for low-income women and minorities – especially black women and those under Medicaid.

The Centers for Disease Control and Prevention (CDC) suggest that some of the increased complications are due to general changes in the US population. For example, the increase in the mother's age, pre-existing medical conditions, and obesity before pregnancy are cited as underlying factors associated with maternal morbidity and mortality. But they can not explain all the disturbing increases described by the AHRQ. More specifically, during the decade of analysis, the report states that rates of sepsis at delivery, acute renal failure and shock more than doubled.

The purpose of the AHRQ's Health Care Cost and Utilization Project was to explore "overall patterns of serious maternal morbidity and mortality while identifying areas of particular concern". But the results should serve as a warning to the country's health system and clearly note the need for hospitals to better integrate teamwork and training strategies into safety culture in labor and delivery.

Although the report provides many detailed statistics on the complications of labor and delivery, here are some of the most important examples (ranging from racial and geographical variation to the probability of complications depending on age):

• The rate of serious complications increased from 101 per 10,000 hospitalizations in 2006 to 147 per 10,000 in 2015 ( Overall increase of 45% ).
• While deaths declined for all races / ethnic groups, hospital mortality was 3 times higher for black women than for white women in 2015 (11 vs. 4 per 100,000 deliveries).
• On average, black mothers were younger than white mothers. But the rate of severe maternal morbidity was between 112 and 115% higher among blacks than whites in 2006 (164 against 76) and in 2015 (241 against 114). This highlights that there has been no change in black-white disparities .
• Hispanics and Asians / Pacific Islanders also had higher rates of serious maternal morbidity than Whites in both years, but disparities decreased over time.
• Serious maternal morbidity was highest among women aged 40 and over and lowest among women aged 20 to 29 (248 and 136 per 10,000 births, respectively). But the under-20s also had more complications than their peers from 20 to 29 years old.
• Some serious conditions involve medical procedures. In 2015, for example, more than half of all deliveries occurred in mothers with shock, amniotic embolism, sickle cell crisis or blood clots throughout the body. 1/3 of the shock deliveries had a hysterectomy.
• In 2015, severe maternal morbidity rates were highest among poor, uninsured or Medicaid mothers, and lived in large urban areas. .
• Compared with deliveries that did not have serious maternal morbidity, those who did were more likely to visit hospitals with a mission to serve vulnerable populations (44% versus 35%), serving minorities (53% vs. 44%). . , teaching (71% vs. 67%) and public hospitals (16% vs. 12%).
• Serious maternal morbidity was also more likely to occur in hospitals in the north-east (18% versus 16%) and in southern hospitals (44% versus 40%) than in Midwestern hospitals (17%). 21%). West (21% vs. 23%).

In order to help hospitals reduce serious maternal morbidity, AHRQ has developed the Perinatal Care Safety Program with the goal of improving communication between hospital staff and overall quality. care in the labor and delivery units. The recommendations are based on a large amount of data and documents from other programs and training systems. With this data in hand, state and federal agencies, patient safety experts and health systems should further assess trends in maternal morbidity, and then commit to taking immediate steps to increase efforts. protection of mothers and children.