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Medical Group Recommends Ways to Improve Maternal Care in Arkansas

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LITTLE ROCK – A group of physicians and nurses conducted an in-depth study of the deaths of pregnant women in Arkansas and submitted their recommendations to the Legislative Council.

They recommend that maternity care providers should increase their understanding of the need to screen for chronic health conditions such as cardiovascular disease, which can worsen during pregnancy and which is a leading cause of pregnancy-related deaths.

The physicians and nurses studied the cases of fatalities during pregnancy, or soon after pregnancy, from 2018 through 2020. During that three-year period, there were 108,517 live births in Arkansas and a possible 121 deaths of Arkansas women associated with being pregnant.

After more review, the group determined that 21 of the deaths should not be included because of faulty data, or because the women actually didn’t live in the state. The group then conducted a detailed analysis of the remaining 100 pregnancy-associated deaths in Arkansas.

It’s important to make a distinction between pregnancy-associated deaths and pregnancy-related deaths. Both refer to deaths that occur either during pregnancy or within a year after the end of the pregnancy. A pregnancy-related death is caused by complications caused by the pregnancy, or the aggravation of health problems caused by being pregnant. A pregnancy-associated death includes all fatalities, regardless of the cause.

Of the 100 deaths, 12 were caused by accidents and were not included in the analysis. Another 33 deaths were excluded because researchers determined they were not related to the women’s pregnancies. In 17 cases the group could not determine if the deaths were related to pregnancy, so they too were excluded. That left 38 pregnancy-related deaths in Arkansas over the three-year period.

The leading cause of death among those 38 was cardiomyopathy, a disease of the heart muscles. The second leading cause was cardiovascular conditions caused by high blood pressure, diabetes, smoking, obesity and age.

The third most significant cause was hypertensive disorders of pregnancy, or HDP. It is considered to be a commonly occurring complication of pregnancy and includes chronic hypertension and pre-eclampsia. Risk factors include obesity, a family history of hypertension and advanced age of the pregnant woman.

Tied for third was infection. The fourth leading cause of death was hemorrhage.

The study was conducted by the physicians and nurses on the Arkansas Maternal Mortality Review Committee, in collaboration with the state Health Department. Their recommendations were submitted to the Legislative Council.

The committee recommended that facilities and providers expand their understanding of the importance of screening for risk factors in pregnant women. Other recommendations would expand access to medical care for women after childbirth.

The committee recommended extending Medicaid maternal coverage from 60 days to one year after women give birth.

According to the group’s report, “postpartum care should be provided to mothers through one year postpartum to monitor the mother’s physical and mental health, provide support during the transition, and ensure access to treatment. This includes extending insurance coverage to ensure access to care and changing care protocols to include regular postpartum visits beyond the current single visit at six weeks postpartum. This lack of attention to maternal health needs is of particular concern given that more than one half of pregnancy-related deaths occur after the birth of the infant.”

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