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Background: Maternal mortality in the United States is high, and women and birthing people of color experience higher rates of mortality and severe maternal morbidity (SMM). More than half of maternal deaths and cases of SMM are considered preventable. The research presented here investigated systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care using patient safety incident reports.
Methods: The authors reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery, and several other process variables. Differences across racial/ethnic group were statistically evaluated.
Results: Almost two thirds (64.8%) of the 528 reports analyzed were reported in L&D, and 35.2% were reported in A&P. Non-Hispanic white (NHW) patients accounted for 43.9% of reported incidents, non-Hispanic Black (NHB) patients accounted for 43.2%, Hispanic patients accounted for 8.9%, and patients categorized as "other" accounted for 4.0%. NHB patients were disproportionally represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds ratio (OR) demonstrated a higher risk of a reported adverse incident for NHB patients; however, adjustment for cesarean section attenuated the association (OR 1.25, 95% confidence interval 1.01-1.54).
Conclusion: Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes. Although additional systems analysis is necessary, the authors offer recommendations to support safer, more equitable maternal care.
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http://dx.doi.org/10.1016/j.jcjq.2023.06.007 | DOI Listing |
BMC Infect Dis
December 2024
Department of Environmental Health, School of Community Health Sciences, Njala University, PMB, Freetown, Sierra Leone.
Background: Polio, a debeilitating and potentially life-threatening disease, continues to pose a risk to young children globally. While vaccination offers a powerful shield, its reach is not always equal. This study explores socioeconomic and geographical inequalities in polio immunisation coverage among two-year-olds in Sierra Leone between 2008 and 2019.
View Article and Find Full Text PDFReprod Health
December 2024
The George Institute for Global Health, Imperial College London, London, UK.
Target 3.7 of the Sustainable Development Goals (SDGs) aims for universal access to sexual and reproductive health (SRH) services by 2030, including family planning services, information, education, and integration into national strategies. In contemporary times, reproductive medicine is progressively incorporating artificial intelligence (AI) to enhance sperm cell prediction and selection, in vitro fertilisation models, infertility and pregnancy screening.
View Article and Find Full Text PDFAnesth Analg
December 2024
From the Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas.
Background: Racial and ethnic disparities in health care delivery can lead to inadequate peripartum pain management and associated adverse maternal outcomes. An epidural blood patch (EBP) is the definitive treatment for moderate to severe postdural puncture headache (PDPH), a potentially debilitating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States.
View Article and Find Full Text PDFBMC Womens Health
December 2024
Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
Background: The World Health Organization has recognized maternal mental illness as an emerging issue. Previous studies have indicated that maternal mental illness is associated with socioeconomic status (SES). However, there is a lack of research concerning the mental health of pregnant people with low SES in Ontario, Canada.
View Article and Find Full Text PDFBMC Health Serv Res
December 2024
Mount Kenya University, Kigali, Rwanda.
Background: Maternal and child health remains a global priority, with antenatal care (ANC) recognized as essential for ensuring positive pregnancy outcomes. Despite significant improvements, in low- and middle-income countries, ANC service utilization remains low in Sub-Saharan Africa. This paper contributes to the understanding of the evolution and determinants of ANC service utilization among women of reproductive age in Rwanda.
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