CTSI Co-leader receives NIH award to improve safety in childbirth

To improve safety in childbirth and to decrease the rising rate of maternal morbidity and mortality, Dr. Kimberly Gregory, co-leader of CTSI's Community Engagement and Research Program and the Integrating Special Populations Program and professor of obstetrics and gynecology at Cedars-Sinai Medical Center, has received an NIH administrative supplement award under the UCLA CTSI grant for her research to evaluate if outcomes are better for women with placenta accreta syndrome (PAS) or placenta previa based on risk-appropriate care. The study will determine if the level of care mitigates observed disparities in severe maternal morbidity (SMM) for these high-risk conditions.

Hemorrhages, such as those that can occur with PAS and placenta previa, are the fourth leading cause of maternal mortality in the United States. Reports suggest that if recognized and managed appropriately upwards of 60-80% can be avoidable, making it one leading cause of preventable maternal death.

The study will be the first to systematically evaluate, at the hospital level, outcomes based on maternal risk-appropriate care. Further, the research intends to provide investigators and hospital systems a framework by which to study different clinical conditions where referral to risk-appropriate care can be evaluated.

“There is an evolving mandate for ‘risk-appropriate’ maternity care similar to neonatal intensive care units, trauma or stroke centers. While it makes intuitive sense that high-risk conditions should be cared for in high-risk centers, more studies are needed to provide the evidence-base to support it,” said Gregory. “This is especially relevant, given maternity deserts—geographic areas where there are no maternity services—and growing concerns about the shortage of clinicians available to provide obstetrical services.”

Gregory, whose additional roles include Director of the Division of Maternal Fetal Medicine and Vice Chair for Women's Healthcare Quality and Performance Improvement in Obstetrics and Gynecology at Cedars-Sinai, believes the research can have lasting impact: “Developing the evidence to support transfer arrangements for poor, rural, or ethnically diverse birthing people to higher levels of care could improve birth outcomes and decrease health disparities.”

The study will utilize California discharge data from 2013-2016 to describe maternal outcomes in women with abnormal placentation—PAS and placenta previa by level of maternal care and race/ethnicity. 

This research is also supported by The Helping Hand of Los Angeles Endowed Chair in Maternal Fetal Medicine.

Image source: UCLA CTSI/Jessica Castillo

Image caption: Kimberly Gregory, MD, leads a study to improve safety in childbirth and decrease the rising rate of maternity morbidity and mortality.