Tuesday, September 28, 2010

Conversation with Dr. Abdulla Al-Khan about maternal mortality

I emailed Dr. Abdulla M. Al-Khan, the maternal-fetal medicine specialist at Hackensack University Medical Center who was quoted in the NBC report on the risks of repeat cesareans. I asked him for more information on placenta accreta-related deaths: Were the numbers the journalist mentioned accurate and indicative of extensive underreporting of maternal deaths? Or had the journalist misquoted or misinterpreted the figures?

This afternoon*, I received a telephone call from Dr. Al-Khan. He was happy to speak with me more about these issues. First off, we talked numbers. Had 40 women in New Jersey died last year due to placenta accreta? He clarified that in 2009, there were about 42 maternal deaths in New Jersey; the journalist had inaccurately interpreted the numbers. Twelve of those 42 deaths he identified as "preventable losses," all related to hemorrhage: placenta accreta, uterine atony, etc. These numbers are very disturbing, he told me, because we're talking mostly healthy, young women. He couldn't give a precise number of how many of those twelve deaths were related to accreta--the figures haven't been released yet--but he said that a good proportion of the twelve were from accreta.

His hospital has seen a lot of placenta accretas. And almost every day, he hears personally from colleagues and other hospitals of another case of placenta accreta. He was very concerned about the high incidence of accreta and emphasized that public awareness of this issue is essential.

We then discussed underreporting of maternal mortality. New Jersey is the only state in the U.S. with a Maternal Mortality Review, which collects and investigates pregnancy-associated and pregnancy-related deaths. The latest Maternal Mortality Review covers 2002-2005 (PDF). Subsequent years will be reviewed in the next report. In those years, maternal mortality figures from New Jersey are as follows:

2002: 39 cases
2003: 49 cases
2004: 51 cases
2005: 34 cases

Of these deaths, slightly less than half were pregnancy-related. The overall maternal mortality rate in New Jersey during those years was 37.4/100,000. The pregnancy-related mortality rate in NJ, a subset of maternal mortality, was 12.6/100,000.

I asked Dr. Al-Khan about the reliability of maternal mortality figures. New Jersey is the only state with reliable figures due to its unique mortality review committee. Underreporting of maternal mortality is a widespread problem in the US. Without a comprehensive state- or nationwide- review process, the figures we have (13.3/100,000 live births as of 2006) still do not accurately reflect the true maternal death rate. (For more information on maternal mortality in the U.S., read Amnesty International's detailed report.) In the United States, litigation is one major factor in this underreporting, because it holds up many details and figures surrounding maternal deaths for several years while litigation is underway.

We concluded our conversation with a brief chat about cesarean rates. He is deeply troubled by New Jersey's 40% cesarean rate, and also by the fact that the national cesarean rate is not far behind.

My academic & blogging activities do not take place in a vacuum. When he called, I was stirring a batch of granola in the oven. Zari was in the kitchen helping. Dio had just woken up from a nap and was a bit cranky. I kept feeding the kids spoonfuls of hot granola to keep them happy and quiet during the phone call. C'est la vie chez les Freezes!


  1. 37.4/100,000!!!!! I know where I won't be having my baby.

    On a more serious note. I am grateful for medical advances and the skill that can save a laboring woman's life. Its incredibly sad that so many of those deaths were considered preventable.

  2. Ashley, New Jersey's numbers are probably not any worse than elsewhere in the US--they're just the most accurately reported.

  3. And the pregnancy related numbers are more important than the general maternal mortality. In 9 years, I've had one patient who ended up included in the maternal mortality stats for my state - but she died of a heroin overdose when her child was still a newborn. Obviously a potentially preventable death, but had nothing to do with the maternity care and delivery care she received.
    It would be good to see more accurate and timely reporting, though. Even though our state does not have the same system, last year we had a state-wide program to prevent bad outcomes from obstetrical hemorrhage and the deaths reported as being from hemorrhage in the last few years were reviewed in the CME presentations. It was good to hear about as a birth attendant, to know what to be watching for and to perhaps be more aggressive at being prepared for those clients that have multiple risk factors, such as multiple previous cesareans.

  4. Way to act out the PWI mandate in your own kitchen =) Sorta!!

  5. Rixa, you ROCK for getting to the bottom of these numbers! I so admire your tenacity in contacting Dr. Al-Khan and verifying the (in)accuracy of the report. (And I do apologize for failing to verify the numbers before publishing them on my site!)

    The accurate numbers of accreta-related deaths are no less sobering, and the issue of placenta accreta is no less serious, but it's great--nay, essential--to have a more accurate picture of the matter.

  6. This is great!

  7. Does anyone know if Dr. Al-Khan is VBAC friendly? My current Dr. is totally against it. I wanted to find a new dr. so I can have that option for my second child.

  8. Hell no he's not. He is a c section king himself


Related Posts Plugin for WordPress, Blogger...