Subjects: Quality and safety
Last fall, the Milbank Memorial Fund authored a white paper on the status of maternity care in the US.
The report concluded that excessive reliance on high tech gadgetry, monitoring and testing made our country by far the most expensive place on Earth to have a baby, yet we graded out average among developed nations when it came to neonatal and maternal mortality.
Last week NIH investigators reported in Obstetrics & Gynecology that if anything, things are getting worse.
Elena Kuklina and colleagues of the National Institute of Child Health and Human Development performed a cross-sectional study of 32 million discharge records from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.
They found that the rate of severe delivery-related complications increased 26% between 1998-1999 and 2004-2005; from 64% per 1,000 deliveries to 0.81%.
Meanwhile, Caesarean deliveries as a fraction of all deliveries rose during the period from 21.2% to 31.1%.
Roughly 2,760 women died from delivery-related complications during the study period, while 227,333 experienced one or more severe complications.
“During the study period, there was a greater than 20% increase in rates of renal failure, respiratory distress syndrome, shock, and ventilation, a 52% increase in rates of pulmonary embolism, and a 92% increase in rates of blood transfusion,” wrote the authors.
The findings could not be explained by differences in maternal age, multiple births (including Octomoms), pre-existing conditions or insurance status.
Increased utilization of C-sections “seemed to explain the observed change over time for renal failure, respiratory distress syndrome, and ventilation,” they wrote.
But that explained only half the rise in blood transfusions, shock and pulmonary embolism, according to the authors. As for the rest of it, who knows?