Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012

Current status and future of cardio-obstetrics-review

Cardio-obstetrics refers to an approach to maternal care that is based upon teamwork with specialists from maternal-foetal medicine, cardiology, anaesthesiology, neonatology, nursing, social work, and pharmacy that work together to achieve appropriate outcomes for the pregnant patient. The aim of this paper is to highlight and provide a narrative review on the currently published research on the current status and future of cardio-obstetrics. A short review on the hemodynamic physiology in pregnancy has also been described in this paper. The authors have discussed the major risk factors associated with exacerbation of pregnancy and the possible remedies that are currently available in this paper in accordance to the updated research. The cardio-obstetrics team provides advice about healthy pregnancy planning before conception. Proper cardio-obstetric care is associated with better outcomes in women with a high cardiovascular risk with decreased adverse maternal and foetal outcomes. Such care should be given to underserved and marginalized communities with great care as they have largely lacked such care in the past. The authors conclude the paper by recommendations to advance this newly emerging field by way of further scientific research and public awareness. This review can serve helpful to any physician working in the healthcare as well as the public that are interested in awareness about the multidisciplinary needs of pregnant women with cardiovascular disease.

Improving Cardiovascular Workforce Competencies in Cardio-Obstetrics: Current Challenges and Future Directions

Maternal mortality in the United States is the highest among all developed nations, partly because of the increased prevalence of cardiovascular disease in pregnancy and beyond. There is growing recognition that specialists involved in caring for obstetric patients with cardiovascular disease need training in the new discipline of cardio-obstetrics. Training can include integrated formal cardio-obstetrics curricula in general cardiovascular disease training programs, and developing and disseminating joint cardiac and obstetric societal guidelines. Other efforts to help strengthen the cardio-obstetric field include increased collaborations and advocacy efforts between stakeholder organizations, development of US-based registries, and widespread establishment of multidisciplinary pregnancy heart teams. In this review, we present the current challenges in creating a cardio-obstetrics community, present the growing need for education and training of cardiovascular disease practitioners skilled in the care of obstetric patients, and identify potential solutions and future efforts to improve cardiovascular care of this high-risk patient population.

Maternal risk factor index and cesarean delivery among women with nulliparous, term, singleton, vertex deliveries, Texas, 2015

BACKGROUND

Cesarean delivery accounts for over one-third of the ~400 000 annual births in Texas, with first-time cesarean accounting for 20% of the overall cesareans. We examined associations of maternal medical comorbidities with cesarean delivery among nulliparous, term, singleton, vertex (NTSV) deliveries in Texas.

METHODS

Nulliparous, term, singleton, vertex deliveries to women aged 15-49 years were identified using the 2015 Texas birth file (Center for Health Statistics, Texas Department of State Health Services). A risk factor index was constructed (score range 0-4), including preexisting/gestational diabetes mellitus, preexisting/gestational hypertension/eclampsia, infertility treatment, smoking during pregnancy, and prepregnancy overweight/obesity, and categorized as 0, 1, 2, and 3+ based on the number of risk factors present. Multivariable logistic regression analyses were conducted to examine associations between the categorized risk factor index and cesarean delivery, overall and by maternal race and ethnicity.

RESULTS

Among the 114 535 NTSV deliveries in Texas in 2015, 27.2% were by cesarean. The most prevalent maternal risk among all deliveries was prepregnancy overweight/obesity (42.4%). The odds of cesarean delivery increased significantly with increasing number of risk factors [one risk factor: 1.72 (95% CI 1.67-1.78); two risk factors: 2.58 (95% CI 2.46-2.71); and three or more risk factors: 3.91 (95% CI 3.45-4.44)].

DISCUSSION

In Texas in 2015, nearly half of NTSV deliveries had at least one maternal risk factor and the odds of cesarean delivery were significantly elevated for women with a higher risk index score. The findings from this study highlight the need for intervening during the preconception and interconception period as intrapartum care practices have an important influence on birth outcomes.