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EXCERPTS FROM AN ARTICLE BY SHERRY BOSCHERT, OB. GYN. NEWS DIGITAL NETWORK
Editor's Note:The Preeclampsia Foundation is one of the 30 organizations that built the following consensus, and we are part of a few of the subcommittees that are still developing the tools and protocols addressed.
Every birthing facility in the United States should have specific practices and equipment to optimize maternal safety in pregnancy, according to a recent consensus meeting of national medical organizations.These include so-called "safety bundles," or safety initiatives, of protocols and equipment for preventing and managing obstetric hemorrhage, venous thromboembolism, and severe hypertension, as well as for supporting patients, families, and staff. Specific early-warning criteria should trigger a maternal evaluation, and facilities should regularly review severe maternal morbidity from a systems perspective.
"Motivated by climbing maternal mortality rates in the United States in recent decades, the recommendations build on preliminary success from California efforts to improve maternal safety," said Dr. Elliott K. Main, who co-chaired the "National Maternal Health Initiative: Strategies to Improve Maternal Health and Safety" consensus meeting in New Orleans in May 2013.
"Maternal mortality rates declined in California since 1970, but started increasing again around 2000, so that by 2005, the rate of 17 maternal deaths/100,000 live births was similar to rates in the early 1970s. Nationally, U.S. maternal mortality rates increased from 1980 to 2008, in contrast with decreases in many other developed countries," he said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.
"Meanwhile, key elements of a 'safety bundle' for hypertension in pregnancy include having unit-standard protocols and policies for the treatment of severe hypertension and eclampsia, safe use of magnesium therapy, and managing magnesium overdose," he said. "The birthing unit also should have an agreed-upon definition of severe preeclampsia, early warning tools employing vital signs and symptoms, and regular review of all hypertension cases with severe morbidity to look for systems issues. The California Maternal Quality Care Collaborative (CMQCC) is expected soon to publish a California Preeclampsia Q1 Toolkit for quality improvement, which will be tested in 26 hospitals," he added.
A poll of the audience found that 31% have a comprehensive, standardized protocol for severe pregnancy hypertension in their hospital, 22% have one that could be improved, 35% don't have one, and 11% had not a clue. (The percentages added up to 99% rather than 100% when the survey results were displayed at the meeting.)