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Statistics

Postby adgirl » Thu Mar 01, 2007 12:33 am

by adgirl (530 Posts), Thu Mar 01, 2007 12:33 am

I did a search on here for statistics on maternal death from PE, and found that about 2 women per week in the US die from this horrible disease. I understand that is well below epidemic proportions, but it's WAY too many in my book.

My question is, does anyone here know how often maternal death happens outside of a first pregnancy? Everyone seems to think that if you're being watched more closely and know the symptoms, you should be okay. Are the statistics much lower for people who have experienced PE before and are under the care of a high risk Dr?

In other words, do you think that if we're under good care and know what to look for that we can prevent maternal death? I know the health of the baby is trickier b/c the disease can cause them to be born so early that there is not much that can be done, but wondering specifically about the mother.
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Re : Statistics

Postby laura » Thu Mar 01, 2007 02:36 pm

by laura (5139 Posts), Thu Mar 01, 2007 02:36 pm

That's a question that I've thought about as well! From what I understand, there's not be a comprehensive study done about maternal mortality from preeclampsia, because it would be very difficult as there is no standard place to report maternal death to, and that the cause of death wouldn't necessarily always just have a preeclampsia diagnosis.

That being said, one of the axioms I find very helpful in placing the problem in perspective is what one of our docs says: Fetal mortality is an indicator of the severity of the disease. Maternal mortality is an indicator of the quality of care the woman received.

There should be NO Reason for a woman in this day and age to die from having a baby- if mom is reporting her symptoms and doc is being responsive, we can extrapolate that to mean that we should have no reason to fear that having our babies will kill us.
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Re : Statistics

Postby sckitzo » Fri Mar 02, 2007 10:57 am

by sckitzo (362 Posts), Fri Mar 02, 2007 10:57 am

I have to disagree. Sometimes their are no symptoms or they can be so suttle that they are not noticed. The other problem is that many of the symptoms are regualar pregnancy symptoms, so they are written off by Both mother and dotors as regular pregnancy signs. Sometimes it just comes on to fast. Sometimes you don't clinicly show you have PE until you are very sick. Most deaths at least of the mother should be able to be prvented, but their always are, and will be exceptions. I do believe that alot fewer mothers die today because of medical treatment. But the Dr's still can't fix everything. Like post partum PE and HELLP. Their big defense for saving the mother is to deliver the Babe, but if that is done already, And you are still getting worse, they can manage the complications, but delivery is'nt a guarantee that everything is fine. PE is described as Bolt of Lighting. I can come that fast. I think that women in their second pregnancies should be able to look for the signs, and hopefully get better care, but their are no promises in life, as we all know. Thier is no cure, delivery can take away the sorce, but it does not "cure the Disorder" At least in my opion. Sorry but this just hit's very close to home. With my son, My husband was told to start makeing Arrangements, They had delivered my son, and had already pulled out all the tricks in thier bag, the only thing left was hope and faith. Medically thier was nothing further to try. Luckily I pulled through, but it was the same for my son. Dr's in this day and age ran out of trick's and he had the best care, but science just can't fix everything yet. Sorry for the long post just a touchy sub for me.
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Re : Statistics

Postby sckitzo » Fri Mar 02, 2007 10:59 am

by sckitzo (362 Posts), Fri Mar 02, 2007 10:59 am

Don't get me wrong I hope with all my heart that not another women or baby will die from this, but that isn't life. Last I read is that a women dies from PE world wide every 12 mins.
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Re : Statistics

Postby deerhart » Fri Mar 02, 2007 11:22 am

by deerhart (3282 Posts), Fri Mar 02, 2007 11:22 am

One of the biggest problems in figuring out the number of PE related deaths is that PE isn't listed on the death certificates. Its usually heart failure, organ failure, embolism etc.. So we are still semi guessing at how many of the maternal deaths in the country are from PE.

BTW the last numbers done (in 2000) on maternal death in the US, its roughly 1 out of every 2400 pregnancies (all causes).
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Re : Statistics

Postby laura » Fri Mar 02, 2007 12:07 am

by laura (5139 Posts), Fri Mar 02, 2007 12:07 am

Amber- I appreciated your comments, so I forwarded a question about the chances of maternal mortality to our Medical Board, and we can see what they say!

I still have to reiterate- it is very unlikely that someone will become critically ill without at least some sort of precipitating symptom; the eclampsia 'bolt of lightning' usually is preceeded by symptom of central nervous system impairment, and is detectable by people who are aware enough to look for it. I read a retrospective study of HELLP syndrome cases and only one out of 14 cases of HELLP syndrome were correctly diagnosed upon admission- if we are aware of the symptoms and active advocates for our care, we can make a positive difference in our outcomes. I'm looking forward to seeing what the doctors have to say!
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Re : Statistics

Postby laura » Fri Mar 02, 2007 01:26 pm

by laura (5139 Posts), Fri Mar 02, 2007 01:26 pm

Here's our first response, I'll make sure they're posted in ATExperts when they're all in:

It depends - of course.


The probability of dying from preeclampsia in the US is very small. If one chose an overall maternal mortality ration of 8/100,000 in the US, then the ratio for preeclampsia is probably no more than 25% of that or 2/100,000. This could approach the risk of a daily activity of riding a bicycle to work for 9 months. With a history of prior preeclampsia, the risk will be raised by an increased incidence of disease but probably lowered by increased awareness and surveillance. When I counsel a woman about attempting a pregnancy after an episode of severe preeclampsia, maternal mortality is not really a consideration.


Now, all of that said, we have a list (or more like a corporate memory) of numbers of cases where a woman has died with preeclampsia in the US. I don't think there are any that entered the pregnancy in the care of a system that had expertise. In a study by Jim MArtin on HELLP and mortality, a large number of deaths (80%) were associated with avoidable delay. (see below)


In the developing world - an entirely different question if we are asking about our global social concern -conscience. I just returned from India where maternal mortality from preeclampsia is "routine."

Am J Obstet Gynecol. 1999 Oct;181(4):924-8.
Links
Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

Isler CM, Rinehart BK, Terrone DA, Martin RW, Magann EF, Martin JN Jr.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.

OBJECTIVE: The aim of this study was to determine factors contributing to deaths among women with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. STUDY DESIGN: Information from multiple sources was scrutinized to distinguish and profile maternal deaths associated with HELLP syndrome. RESULTS: Information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal deaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), disseminated intravascular coagulopathy (39%), adult respiratory distress syndrome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), and hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndrome was implicated in 22 of 43 patients' deaths (51.1%). CONCLUSIONS: It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mortal consequences, and (3) hemorrhage in the hepatic or central nervous system or vascular insult to the cardiopulmonary or renal system were associated with increased mortality risk.





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Re : Statistics

Postby laura » Fri Mar 02, 2007 01:28 pm

by laura (5139 Posts), Fri Mar 02, 2007 01:28 pm

quote:
Originally posted by Laura



There should be NO Reason for a woman in this day and age to die from having a baby- if mom is reporting her symptoms and doc is being responsive, we can extrapolate that to mean that we should have no reason to fear that having our babies will kill us.



I think I need to revise my statement- instead of saying we should have *no* reason to fear dying from the disease, I should say instead, "we should have very little reason to fear that having our babies will kill us.

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Re : Statistics

Postby cindync » Fri Mar 02, 2007 01:49 pm

by cindync (542 Posts), Fri Mar 02, 2007 01:49 pm

Wow, that is just scary.
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Re : Statistics

Postby catherine » Fri Mar 02, 2007 02:17 pm

by catherine (2832 Posts), Fri Mar 02, 2007 02:17 pm

The starkest realities lie in the difference in medical options available to support maternal health after the onset of preeclampsia. Of the co-morbid complications associated with HELLP syndromes I had to deal with two, disseminated intravascular coagulation and renal failure. As part of the excellent medical care I received I needed and obtained in sufficient time, red cells, platelets and plasma, additional surgery and dialysis for my renal failure. If I had not managed to make it, it wouldn't have reflected poorly on the medical staff who treated me. However, dying for lack of a pressure monitoring device and the inavailability of MgSO4 in an IV with the trained staff to administer it.... is WRONG, and is the reality for many pregnant women world wide.
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