MedicalResearch.com Interview with:
Joel Ray MD, MSc, FRCPC
Institute of Health Policy, Management and Evaluation
Faculty of Medicine
University of Toronto, Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many women who die within childbirth or soon thereafter experience rapid onset of morbidity/illness before succumbing. Thus, severe maternal morbidity (SMM) offers a detectable (or set of detectable) conditions that might be dealt with before they progress to a fatality. Even so, severe maternal morbidity alone can be non-fatal, but create disability for a new mother (e.g., a stroke), or prolong separation of mother and newborn.
So, we showed that, as the number of severe maternal morbidity indicators rises, so does the probability of maternal death. This relation was exponential in nature.
MedicalResearch.com: What should readers take away from your report?
Response: Severe maternal morbidity can be identified, and sometimes, prevented, thereby reducing not only the chances of a woman dying around the time of giving birth, but also normalizing pregnancy, birth and new motherhood.
Initiatives to prevent severe maternal morbidity (e.g., aspirin to prevent preeclampsia, magnesium sulphate to prevent eclampsia, blood pressure control to prevent acute stroke, or tranexamic acid to alleviate postpartum haemorrhage) have an evidence base that is strong.
Also, early warning systems can identify, early on, a woman whose physical status is rapidly in decline, and who may then need rapid escalation of care.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need better tools to generate easy-to-use and accurate early warning systems for maternal decline. We need to optimize preventive strategies that can reduce certain severe maternal morbidity indicators, such as for preeclampsia or postpartum hemorrhage.
We also need to develop ways to address mental illness and self-harm among women who may have already left hospital, and who are not coping with sleeplessness, massive hormonal changes, and the stress of new motherhood.
Ray JG, Park AL, Dzakpasu S, et al. Prevalence of Severe Maternal Morbidity and Factors Associated With Maternal Mortality in Ontario, Canada. JAMA Netw Open. 2018;1(7):e184571. doi:10.1001/jamanetworkopen.2018.4571
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