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:
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!
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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!
