The Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) recently released a report that indicates between 2006 and 2015 the rates of women are experiencing serious life-threatening complications while giving birth increased by 45 percent. Researchers discovered that rates of kidney failure, shock, sepsis, and ventilator use have more than doubled during the same amount of time, while blood transfusions increased by 54 percent. The HCUP databases come from hospital administrative data and include information on diagnoses and procedures, patient discharge status and patient demographics, as well as the hospitals’ charges.
“This report provides an essential update to our understanding of an urgent public health issue,” said AHRQ Director Gopal Khanna, M.B.A. “With these data in hand, State and Federal agencies, patient safety experts and health systems can evaluate maternal morbidity trends in greater depth, a vital step before addressing the challenge.”
Study co-author, Megan Hambrick, an AHRQ program analyst, also called the increasing complication rate “an urgent public health issue in this country despite what people might want to believe.” She added, “Our study also highlights significant racial and ethnic disparities.”
The highest rates of severe complications occurred in mothers over age forty, as well as those who are poverty-stricken, uninsured, on Medicaid, or living in large urban areas. African American and Hispanic women were more likely to experience serious complications compared with Caucasian women.
Complications rose from 101 per 10,000 deliveries to 147 per 10,000 deliveries over the decade documented, according to the report. African American women were 110 percent more likely to experience life-threatening problems and Hispanic women were 40 percent more likely to experience complications than Caucasian women.
“The statistics presented are certainly disturbing, and in line with all the recent publicity surrounding this problem around the country,” said Dr. Alan Peaceman, a high-risk obstetrician at Northwestern Medicine. “It does not determine, however, the causes of the increase in severe maternal morbidity over the 10-year timespan. On the healthcare side, the rise in the rate of cesarean sections may be contributing to the increase in morbidity. Patient changes that could be factors including increasing rates of obesity and diabetes, older maternal age, and use of infertility treatments.”
Dr. Andrew Satin, the Dr. Dorothy Edwards Professor and director of gynecology and obstetrics at Johns Hopkins Medicine in Baltimore, Maryland, added, “Older women are getting pregnant as well as women with preexisting conditions…Obesity is clearly a contributor. And our use of cesarean delivery really contributed to this. When more women are having cesarean sections there’s more risk for hemorrhage. And repeat cesarean sections create more risk for hemorrhage.” He added of C-sections, “In a normal delivery, the placenta naturally separates from the uterine wall. When there is scar tissue sometimes the placenta doesn’t come out or it comes out in pieces. That can lead to hemorrhage, at which point a hysterectomy can be life-saving.”
Hospital staff needs to be prepared for emergencies, Satin explained, saying, “you should have a hemorrhage cart that’s stocked with the devices and medications commonly used. And there should be a team that’s used to dealing with massive hemorrhages. And a checklist on the wall, so nobody forgets what to do…I believe we can do better and we should do better.”