The United States maternal mortality ratio is three to four times higher
than that of most other developed nations, suggests data from the Centers for Disease Control and Prevention. The maternal mortality ratio
is increasing, reaching 21-22 per 100,000 live births in 2014 (more
than double from 1990). Although much has been written about this
problem, few solutions have been forthcoming.
In a study to be presented in the oral concurrent
session at 1:15 p.m. PST, at the Society for Maternal-Fetal Medicine's
annual meeting, The Pregnancy Meeting, researchers with the Baylor
College of Medicine in Houston, Texas, presented the study titled
'Association between day and month of delivery with maternal-fetal
mortality: weekend effect and July phenomenon in current obstetric
‘Most women with pregnancy complications known to lead to death actually deliver on weekdays, suggesting that the actual problem with weekend deliveries is even greater.’
The researchers of this study wanted to know if maternal and fetal
death ratios were higher on weekends versus weekdays or during different
months of the year. "We were interested in this study because we
believe this data provides a valuable window into the problems with the
U.S. system of obstetric care delivery," said Amirhossein Moaddab with the department of obstetrics and gynecology at Baylor College of
Medicine and the presenter of the study at the SMFM annual meeting.
The researchers analyzed more than 45 million pregnancies in the
U.S. between 2004 and 2014 to determine if there are significant
differences in ratios of both maternal deaths and stillborn deliveries
depending on the day they occurred. Weekend delivery is also associated
with differential maternal and neonatal morbidity, including increased
ratios of perineal lacerations, maternal transfusions, neonatal
intensive care admissions, immediate neonatal ventilation requirements,
neonatal seizures and antibiotic use.
"We were able to control for pregnancy complications, and found that
most women with pregnancy complications known to lead to death actually
deliver on weekdays, suggesting that the actual problem with weekend
deliveries is even greater," Steven L. Clark, senior author of the
Researchers also looked at months of the year
including "July phenomenon," the month of the year that is associated
with an increased risk of medical errors and surgical complications that
occurs in association with the time of year in which United States
medical school graduates begin residencies. The researchers found no
association between maternal-fetal mortality and July.
Clark continued, "Any system that shows this sort of variation in
the most important of all system outcomes is, by definition, badly
broken. Our data suggest that a part of the overall dismal U.S.
obstetric performance may be related to this systems issue, that is,
there may be a 'spill over' effect that is demonstrably worse on
weekends but is also present on weekdays to a lesser extent."
does not allow us to go any further than this in terms of specifying
what the problem is. However, we believe it is likely due to the fact
that rarely is care of the pregnant inpatient the primary concern of the
treating physician - it is almost always a distraction from office,
surgery or personal activities."
The researchers determined that by addressing this study and
improving the obstetric quality of care on weekends by different
methods, such as expanded use of the hospitalist or laborist model, will
be one important component of addressing this issue.