Rutgers physicians have ramped up care for expectant mothers to help reduce maternal deaths and other severe complications during and after pregnancy.
Rates of maternal deaths and premature births have increased nationwide in recent years, with New Jersey among the states reporting the most worrisome statistics, according to the Centers for Disease Control and Prevention (CDC).The CDC reported 16 pregnancy-related maternal deaths for every 100,000 live births nationwide in 2012, the most recent year for which data is available, up significantly from a low of 7.2 in 1987. The most recent state data indicates that from 2006 to 2008, New Jersey’s average mortality rate was 14.4 maternal deaths per 100,000 births, with higher mortality rates reported for black women, consistent with the CDC’s national statistics.
Rutgers’ Joseph Apuzzio, chair of the State of New Jersey maternal review committee that studies cases of women who die during or within a year after pregnancy, notes that while the statistics might be somewhat misleading due to enhanced identification and reporting efforts, they underscore the need for greater awareness and education.
“Only 27 states have formal maternal review committees,” says Apuzzio, vice chair of Obstetrics, Gynecology and Women’s Health at New Jersey Medical School, “so in the U.S. we don’t really know the precise number of maternal deaths related to pregnancies. But we’re getting better at identifying potential causes and what we as a profession can be doing differently to prevent morbidity and mortality.”
Efforts by faculty at Rutgers’ New Jersey Medical School (NJMS) in Newark and Robert Wood Johnson Medical School (RWJMS) in New Brunswick are aimed at encouraging expectant mothers to alert their health care providers of any potential health irregularity and teaching future physicians to respond to all maternal health complaints, however minor they appear.
“A headache for a pregnant woman may signify more serious conditions than for a non-pregnant patient,” says Gloria Bachmann, RWJMS interim chair of Obstetrics and Gynecology and associate dean for women’s health, “and we must intervene quickly. Headaches may signal dangerously high blood pressure, which may ultimately lead to toxemia of pregnancy, adversely affecting both the mother and her baby.”
Bachmann and Apuzzio recently collaborated on a program, ‘Stop. Look. Listen!,’ teaching Rutgers medical and nursing students best practices in caring for pregnant women and intervening whenever suspicious symptoms arise. The education day featured a new technique in teaching, referred to as immersion education. RWJMS Ob/Gyn and Family Medicine faculty assisted in developing an interactive video that illustrates clinical outcomes that can result from appropriate or inappropriate treatment options.
In addition to maternal mortalities, preterm birth rates are also rising nationwide, according to a recent March of Dimes report. New Jersey was graded “C” for its 9.8 percent preterm birth rate — fewer than 37 weeks of pregnancy — compared to the March of Dimes’ 8.1 percent goal by 2020. Essex County (11.2 percent) and Middlesex County (9.2 percent) rank among the New Jersey counties with the highest premature birth rates.
Babies born after 23 weeks of pregnancy may survive but are at high risk of developing significant brain, breathing or cognitive developmental issues. NJMS and RWJMS focus on creating the most efficient interventions to prolong pregnancies.
A progesterone medication therapy to relax the uterine muscle may be given as early as 16 to 20 weeks into the pregnancy of a woman who has had a previous preterm birth. A stitch to help keep the cervix closed also is popularly used now to help extend pregnancies, says Lisa Gittens-Williams, associate professor, NJMS Department of Obstetrics, Gynecology and Women’s Health.
“But in addition, we need to continue to manage the chronic medical issues, such as high blood pressure, diabetes and hypertension which can lead to the need for premature delivery if not treated properly,” Gittens-Williams says.
The National Academy of Science estimated that preterm births cause $26 billion in annual avoidable medical and societal costs.
Both Rutgers medical schools recently implemented several protocols, which include: imploring expectant moms and their families to alert health care providers with any new symptoms during all stages of pregnancy; identifying and treating women deemed most vulnerable for premature delivery; and encouraging appropriately screened women who’ve delivered previously by cesarean section to attempt natural delivery, hoping to avoid potential repeat C-section surgical complications.
NJMS recently created a pregnancy medical “home,” which includes a patient care coordinator, navigator and social worker, to help ensure that a patient attends her scheduled appointments and keeps her health care providers aware of any change in her condition. At RWJMS, a new three-dimensional virtual obstetrical tour shows mothers-to-be what to expect at their medical visits and the site where their care will occur.
“Being in a 3-D world in a relaxed situation will hopefully take the fright out of coming back for care when a pregnancy concern arises,” Bachmann noted.
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