Upload
trinhngoc
View
213
Download
0
Embed Size (px)
Citation preview
Levels of Maternal Care: A Primer for MCH Programs
M. Kathryn Menard, MD, MPH Professor, Obstetrics and Gynecology
Division Director for Maternal-Fetal Medicine
Co-Director Center for Maternal and Infant Health
UNC School of Medicine
Past President (2012-13), Society for Maternal Fetal Medicine
U.S. Maternal Mortality
0
5
10
15
20
25
30
35
40
1982 1985 1988 1991 1994 1997 2000 2003 2006 2009
Ma
tern
al
De
ath
s p
er
10
0,0
00
Liv
e B
irth
sTotal White Black
Maternal Mortality Ratios in Selected
Countries over the Past 30 Years
0
5
10
15
20
25
Mat
ern
al M
ort
alit
y R
atio
(
per
10
0,0
00
bir
ths)
Hogan et al, Lancet 2010; 375: 1609–23
ç 20102010ç
3
9.0
6.5
12.5
10.0
15.0
10.1
17.0
10.9 9.9
16.5 7.6
10.5
20.1
7.1
9.0
9.0
10.3 5.0
10.9
7.8
8.2
12.7
16.0
17.9
11.6
11.0
21.0
10.1
18.9
2.6
20.9
14.8
19.0
8.2
12.0
10.9
18.7 7.2 10.3
10.4 8.3
16.5
7.5
4.8
1.2
5.2
2.9
9.2
MATERNAL MORTALITY PER 100,00 LIVEBORN INFANTS
Source: NLWC from Center for Disease
Control and Prevention, National
Center for Health Statistics 1999-2006
> 18.0
13.0 -18.0
<13.0
Severe Maternal Morbidity
Between 1998-1999 and 2008-2009 severe morbidity during delivery hospitalization increased ~75%
(7.4-12.9 per 1,000 deliveries)
Blood transfusions, acute renal failure, and aneurysms each more than doubled
Callaghan Obset Gynecol Nov 2012
Since TIOP, the
conceptual framework for
regionalization of care of
the woman and newborn
has changed to focus
almost entirely on the
newborn
Annual Birth Volume
in U.S. Hospitals, 2008 N
UM
BER
S O
F H
OSP
ITA
LS
n = 3,265 Simpson KR, JOGNN 40, 2011
Levels of Maternal Care (LOMC)
• Uniform designations of LOMC that are
complimentary but distinct from levels of
neonatal care
• First ever ACOG/SMFM guidance that
establishes levels of care specific for the
pregnant woman
» An effort to ensure all birthing facilities “are
tooled to take good care of moms”
» Not about closing small hospitals, but about
preparing them
OB Care Consensus #2. February 2015
Levels of Maternal Care (LOMC)
• Inclusivity demonstrates by:
» Inclusion of Birth Centers
» Additional endorsement and support from
AABC, ACNM, AWHONN, Commission for the
Accreditation of Birth Centers, AAP, ASA,
SOAP
• Emphasizes role of Level III/IV (Regional)
Centers to support education and quality
improvement among their referring facilities
» Building a culture of collaboration