Sadly, California is unlikely to be unique in this regard. Maternal death rates have probably increased in other states and in the country as a whole as well. On January 26th, the Joint Commission issued a Sentinel Event Alert to hospitals, notifying them that “current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.” The Commission acknowledged that that incidence of maternal death remains low at an estimated 13.3 deaths per 100,000 live births and that a possible reason for the increases seen is better identification of women who die during or shortly after pregnancy. Still, the Commission quoted the CDC’s Dr. William M. Callaghan as follows: “[T]here clearly has been no decrease in maternal mortality in recent years, and we are not moving toward the U.S. government’s Healthy People 2010 target of no more than 3.3 maternal deaths per 100,000 live births.” Moreover, “[m]aternal deaths are the tip of the iceberg for they are a signal that there are likely bigger problems beneath some of which are preventable,” says Dr. Callaghan. “It is important to consider the women who get very, very sick and do not die, because for every woman who dies, there are 50 who are very ill, suffering significant complications of pregnancy, labor and delivery.”
Not all maternal deaths are preventable, of course. To reduce the rate of those that are, the Joint Commission suggests a number of actions for hospitals and physicians to take, including participating in state-level maternal mortality reviews and developing protocols (and holding drills to train staff on the protocols) for responding to conditions such as hemorrhage and pre-eclampsia. More concretely, the Commission quotes Dr. Steven L. Clark of the Hospital Corporation of America who argues that the “only cause of maternal death amenable to nationwide systematic prevention efforts is pulmonary embolism [a blood clot in the lung].” Disappointingly, while nearly all adult patients undergoing major surgery receive prophylactic measures for the prevention of venous thromboembolism (VTE) even patients with no risk factors for the condition pregnant women undergoing Cesarean delivery traditionally do not, despite the fact that they at increased risk. In light of the Commission’s Sentinel Event Alert, it seems to me that hospitals would be well-advised to adopt VTE prophylactic measures for all pregnant women undergoing Cesarean sections at once. Is there a downside I am missing?