CPM Winter 2020 - 27

daup h i n c m s .o rg

noncommunicable diseases (NCD) now first 6 weeks postpartum. Increasing shortness and medication history. A woman whose
contribute greatly to this unwelcome trend. of breath may be first signs of cardiomyopathy mother had preeclampsia has a 25% chance
These diseases include heart disease, hyper- or thromboembolism. Worsening fatigue of developing the same disorder whereas
tension, obesity, thromboembolism (clots in may be symptoms of worsening depression, it is only 5% if her mother-in-law had the
lungs from legs or pelvis), diabetes mellitus, postpartum thyroiditis or multiple sclerosis disorder. Postpartum hemorrhage in a prior
thyroid disorders, mental illness and substance flare. One out of six pregnancies are affected pregnancy is an indicator of increased risk for
use disorders, stroke, multiple sclerosis and by diabetes mellitus, most of which is con- repeat. Prolonged labor, emergency Cesarean
epilepsy. Planning for pregnancy only happens fined to the pregnancy, but can persist. The section, multiple pregnancy and excess amniotic
in half of US pregnancies so chronic medical recommended testing for resolution of the fluids predispose to hemorrhage. Too often
conditions are not addressed and optimization diabetes is at 6 weeks.
practitioners do not inform the patient she
of maternal health does not occur prior to
is
gaining too much for fear of offending or
What are the issues we can manage since
conception. A recent Reuters article cited the 60% of maternal deaths are preventable? alienating her. Cultural beliefs that accuse the
decreasing access to health services for women Some issues that we cannot reduce are that woman of not eating enough and need to eat
by facilities such as Planned Parenthood and US women are older. With being older the for two makes the practitioner's or clinic's job
subsequent lack of contraceptive services as women often have chronic medical problems harder to avoid excess weight gain. Losing
cause of further increase in maternal mortality which may be impacted by pregnancy. The weight postpartum is equally important as it
and severe morbidity. Ethical practitioners who woman, the office or clinic, and the hospital will counteract our country's increasing trend
deliver health care to women include pregnancy all can contribute to reducing risks.
towards obesity.
prevention before pregnancy occurs. Religious
The hospital or birthing center must be
The woman should have a preconception
beliefs regarding the unplanned pregnancy will
prepared
for postpartum hemorrhage and this
visit aimed at optimizing her health. Since
dictate counsel and/or referral.
is
best
done
by having simulation drills. Since
the woman will have at most less than an
Philadelphia now has the highest maternal hour of visit out of the fifty-two weeks in a 80% of postpartum hemorrhage is related to
death rate of any major US city, recently year, she needs to take charge of her health uterine atony, familiarity with medications
replacing Chicago for that spot. Late post- by achieving ideal body weight before preg- that contract the flabby uterus after vigorous
partum deaths occur in more than 50% in nancy, eat a healthy diet with fresh fruits and massage fails and their safety and contraindiPhiladelphia exceeding the 33% in most other vegetables, have adequate intake of iron and cations as well as surgical remedies should be
regions. There are extremely disturbing findings B12 containing foods, avoid tobacco, alcohol, reviewed with all professional staff members.
in Philadelphia. If you are African-Amer- and marijuana, opioid and other illicit drug Hypertensive emergencies should also be
ican, you are 10 times more likely to die; usage, having adequate exercise and sleep part of drills. Many hospitals now have crash
African-American women constitute 75% of patterns, and being grounded in a supportive carts where fluids and medications are readily
maternal deaths in Philadelphia. Educational and caring community. Medication usage available. Important signs of excess blood loss
achievement does not protect women from for medical conditions need to be reviewed that are often ignored or neglected are air
death; an African-American woman with as some can harm a fetus. The angiotensin hunger and restlessness or agitation.
college education or more is still 5.2 times receptor blockers (ARBs) commonly used
Reducing maternal mortality is a team
more likely to die in the pregnancy or in the for hypertension and some cardiac ailments effort beginning with education and resources.
first year. Nationally the highest risk group is must be changed to another class of drug to Providing adequate access to care through
African-American woman 40 or over. When prevent fetal harm. Valproic acid, a relatively insurance coverage is one way the government
Medicaid which pays for almost 50% of all inexpensive medication used for seizure dis- and other insurers can help.
US pregnancy care abruptly terminates at 42 orders, migraine prevention, and psychiatric
days, the indigent woman does not seek care, disorders, has been linked to brain, spinal cord
fears she will be denied care, or will be unable and cleft palate in the fetus; medication usage SOURCES
to pay for care - all the while trying to care for needs to be discussed with her practitioner. As Trends In Maternal Mortality 2000-2017 estimates by
her newborn and herself. Medication assisted the woman's body mass index (BMI) increases, WHO, UNICEF, UNFPA, World Bank Group and the
treatment (MAT) of substance use disorders there is a higher incidence of blood clots in United Nations Population Division
often is abruptly stopped at the 42-day mark; legs, pelvis, lungs and brain. Avoiding excess Maternal Mortality in Philadelphia 2010-2012 released
these women who now have an infant to care weight gain in pregnancy is also important as May 2015
for as well as themselves are stressed by their excess weight will predispose her to diabetes "Black Women Disproportionately Suffer Complications of
Pregnancy and Childbirth. Let's Talk About It:" Adriana
unsatiated craving and return to the drug dealer and hypertension while putting more stress Gallardo, reporter for ProPublica, December 8, 2017
seeking relief. What she does not realize is that on her heart.
https://www.reviewtoaction.org
her tolerance to the chosen substance has been
The office or the clinic seeing the woman https://www.health.pa.gov/topics/healthy/Pages/Materlowered and that dose often produces death.
nal-Mortality.aspx
preconception should review medical, surgical,
Many of the NCDs are not evident in the prior pregnancy history as well as family, social https://www.cdc.gov
Central PA Medicine Winter 2020 27

http://www.dauphincms.org https://www.reviewtoaction.org https://www.health.pa.gov/topics/healthy/Pages/Mater https://www.cdc.gov

CPM Winter 2020

Table of Contents for the Digital Edition of CPM Winter 2020