Washington Hill

A 6-year (2004-2009) review of maternal mortality at the Eastern Regional Hospital, Koforidua, Ghana.

A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths.

Neonatal brachial plexus palsy

The American College of Obstetricians and Gynecologists convened the Task Force on Neonatal Brachial Plexus Palsy to develop a comprehensive report summarizing a scientific literature on this subject. Clinically, neonatal brachial plexus palsy (NBPP) presents in a newborn as a weak or paralyzed upper extremity, with the passive range of motion greater than the active. The overall incidence of NBPP, both transient and persistent impairment, is 1.5 per 1,000 total births. Multiple reports in the peer-reviewed literature describe the occurrence of NBPP without concomitant clinically recognizable shoulder dystocia at the time of both vaginal and cesarean delivery. Chapter 1 of the report details the incidence of NBPP.

Pregnancy-Associated Mortality Review: The Florida Experience

At the beginning of the 20th century, maternal mortality was a leading cause of death for women of reproductive age in the United States. Obstetrical care was not standardized, and there was a lack of universal systems for monitoring maternal deaths. Public health efforts of surveillance, along with advances in medicine and sanitation, resulted in a significant decrease in maternal deaths by the early 1980s. Today, maternal death is considered to be a rare event; however, the rates of maternal mortality have not improved in almost 3 decades. There is growing evidence that many maternal deaths can still be prevented through enhanced surveillance that influences improvements in overall health and delivery of care. This paper describes the experience of establishing and maintaining a pregnancy-associated mortality surveillance system in Florida. Emphasis is placed on the process and importance of a statewide review and the value of engagement with the medical community.