Maternal mortality--a review of current trends.

Pregnancy-related maternal deaths, although rare,are higher than the public health goal of no more than 3 per 100000 live births [5,6]. Achievement of this goal mandates complete and consistent reporting of all maternal deaths to identify causes of death accurately and correct underreporting [2]. Racial disparity between white and African American women must be reduced. Further research is needed to identify the factors contributing to the higher mortality rates in the African American population. Risk factors currently identified with adverse perinatal outcomes do not explain the differences in mortality rates adequately. Perinatal nurses and primary care providers should take an active role in identifying current trends in causes of matemal mortality. The population of women encountered daily in perinatal units is changing, with an increasing number of pregnancies complicated by preexisting and pregnancy-related medical conditions. Caring for these women within the framework that pregnancy is a normal, physiologic state can lead to complacency and increase the probability of missing early signs of maternal decompensation from an undiagnosed cardiac lesion, because shortness of breath and decreased exercise tolerance are considered normal changes as the pregnancy advances. Common complaints of pregnancy often mimic early signs of cardiopulmonary compromise, delaying an accurate diagnosis. The perinatal nurse must be aware of the early signs of an impending cardiopulmonary arrest. If recognized. subtle changes in levels of mentation, increasing pulse and respiratory rates, and changes in blood pressure lead to earlier interventions to correct maternal hemodynamic status and possibly prevent cardiopulmonary collapse. To further complicate the issue, the mindset in perinatal units often is, "It can't happen here" or "We don't have codes in obstetrics."Perinatal units should practice emergency drills, including management of eclampsia, hemorrhage, and cardiopulmonary arrest. Rehearsal of the emergency situation helps decrease anxiety for the staff and increase response times. The goal of the irreducible minimum for prevent-able maternal deaths is one to strive for in today's perinatal practice. Active surveillance to identify causes of maternal mortality allows for initiation of early interventions to minimize maternal compromise, thereby decreasing preventable deaths.