The Problem
Maternal mortality in the US is unacceptably high, the worst in the developed world at an average of 23.8 deaths per 100K births and rising. Health inequities are growing; black mothers die at 3.5 times the rate as white mothers; Native American/Alaskan Indian mothers at 2.5 times. Hispanic maternal mortality rates have been growing at a 24% CAGR over the past several years.
Source: Elflein, John; Maternal Mortality Rates In The US from 2018 - 2020, by Ethnicity; May 10, 20222; statista.com/statistics/1240107/us-maternal-mortality-rates-by-ethnicity/
11% of these deaths are attributable to postpartum hemorrhage (PPH). PPH is the leading cause of maternal death in labor and delivery and up to six days postpartum. PPH is preventable, but can kill a woman in hours if it goes undetected and/or untreated. For every woman who dies, fifty experience morbidities like unplanned hysterectomies, kidney injuries and blood transfusions, extending length of stay and negatively impacting mother-child bonding and patient experience.
Most Frequent Causes of Pregnancy Related Deaths
Initial Focus: Improving PPH Risk Prediction
PPH occurs in 5% of all births globally, 185K in the US alone. An astonishing 40% of patients who experience PPH have no identifiable risk factors. If the care team is not vigilant in detecting and treating a hemorrhage, valuable time is lost. In today’s environment, hospitals are already dealing with staffing shortages, the high rate of clinician burnout and a sicker maternal patient population due to the COVID-19 pandemic.
Better risk prediction is an imperative as current detection practices are imperfect. For decades, estimated blood loss has been widely used, despite its propensity to underestimate by 30 to 50%. Vital signs are lagging indicators. Continuous risk assessment for PPH would save lives and avoid complications, improving equity in obstetrics care.