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. 2022 Feb 6;6(1):e12656.
doi: 10.1002/rth2.12656. eCollection 2022 Jan.

Disparities in obstetric hemorrhage outcomes

Andra H James  1 , Jerome J Federspiel  1 , Homa K Ahmadzia  2
Affiliations

Disparities in obstetric hemorrhage outcomes

Andra H James et al. Res Pract Thromb Haemost. .

Abstract

Both the maternal and fetal outcomes of pregnancy vary greatly according to a pregnant woman's community and her condition. The most devastating outcome is the death of a mother. In 2017, there were ≈295,000 maternal deaths globally with dramatic differences in maternal mortality based on geographic region, country, and women's underlying conditions. Worldwide, the leading cause of maternal death is hemorrhage, comprising 94% of maternal deaths, with most cases occurring in low- or middle-income countries. Whether a hemorrhage originates from inside the uterus (80%-90%), from lacerations or incisions (10%-20%), or from an underlying coagulopathy (<1%), an acute acquired coagulopathy will evolve unless the hemorrhage is controlled. In low- or middle-income countries, the full range of resources to control hemorrhage is not available, but besides the usual obstetric measures, blood availability, hemostatic medication, and hematologic expertise are necessary to save mothers' lives. Hemostasis and thrombosis experts can address the disparities in obstetric hemorrhage outcomes not only as providers but as consultants, researchers, and advocates.

Keywords: blood availability; coagulopathy; hemorrhage; maternal mortality; pregnancy.

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Figures

FIGURE 1
FIGURE 1
Maternal mortality ratios (maternal deaths per 100,000 live births) by country, 2017. Source: World Health Organization (WHO). https://apps.who.int/iris/bitstream/handle/10665/327596/WHO‐RHR‐19.23‐eng.pdf?ua=1. Accessed September 13, 2021. Figure used with permission of WHO
FIGURE 2
FIGURE 2
Maternal mortality ratios (maternal deaths per 100,000 live births) by region, 2017. Source: World Health Organization (WHO). https://www.who.int/reproductivehealth/publications/maternal‐mortality‐2000‐2017/en/ Data accessed February 7, 2021
FIGURE 3
FIGURE 3
Disparities in the maternal mortality ratio (maternal deaths per 100,000 live births) in the United States by race/ethnicity, 2016. Source: US Centers for Disease Control and Prevention Racial/Ethnic Disparities in Pregnancy‐Related Deaths — Maternal Mortality Ratios. United States, 2007‐2016. https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm Data accessed September 13, 2021
FIGURE 4
FIGURE 4
Blood donations per 1000 population by countries’ income, 2018. Sources: World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank Group, and the United Nations Population Division. Blood safety and availability. https://www.who.int/news‐room/fact‐sheets/detail/blood‐safety‐and‐availability. Data accessed February 7, 2021
FIGURE 5
FIGURE 5
ISTH membership per million population. Source: ISTH Membership Directory. https://www.isth.org/search/ Data accessed June 16, 2021
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References

    1. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368‐1373. - PubMed
    1. World Health Organization , UNICEF , United Nations Population Fund , The World Bank . Trends in maternal mortality: 2000 to 2017 [Monograph]. Geneva, CH: WHO; 2019.
    1. CDC . Infographic: racial/ethnic disparities in pregnancy‐related deaths — United States, 2007–2016 [cited 2021]. Available from: https://www.cdc.gov/reproductivehealth/maternal‐mortality/disparities‐pr...
    1. Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453‐1463. - PubMed
    1. Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018;61(2):387‐399. - PMC - PubMed