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Disparities in obstetric hemorrhage outcomes.
Andra H James1, Jerome J Federspiel1, Homa K Ahmadzia2
1Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Duke University Durham North Carolina USA.
Research and Practice in Thrombosis and Haemostasis
|February 11, 2022
Summary
Maternal deaths globally, primarily from hemorrhage, are high, especially in low-income nations. Hemostasis experts can improve obstetric hemorrhage outcomes through consultation and advocacy.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Global Health
Background:
- Maternal and fetal outcomes of pregnancy are influenced by community and individual health status.
- Global maternal deaths in 2017 were approximately 295,000, with significant regional disparities.
- Hemorrhage is the leading cause of maternal death worldwide, particularly in low- and middle-income countries.
Purpose of the Study:
- To highlight the disparities in maternal mortality due to obstetric hemorrhage.
- To emphasize the critical role of hemostasis and thrombosis experts in managing obstetric hemorrhage.
- To advocate for improved resources and expertise in low- and middle-income countries.
Main Methods:
- Review of global maternal mortality data.
- Analysis of causes and origins of obstetric hemorrhage.
- Discussion of resource limitations in low- and middle-income countries.
Main Results:
- Hemorrhage accounts for 94% of maternal deaths globally.
- Obstetric hemorrhage can stem from uterine sources (80%-90%), lacerations/incisions (10%-20%), or coagulopathy (<1%).
- Acute acquired coagulopathy develops if hemorrhage is not controlled.
Conclusions:
- Addressing obstetric hemorrhage disparities requires more than standard obstetric measures.
- Availability of blood products, hemostatic medications, and hematologic expertise is crucial.
- Hemostasis and thrombosis experts can significantly impact maternal survival rates as providers, consultants, researchers, and advocates.
