Reducing Maternal Morbidity on the Frontline: Acute Care Physical Therapy After Cesarean Section During and Beyond the COVID-19 Pandemic

摘要

Cesarean section is the most common surgery in the United States.1,2 Approximately 1.2 million women per year undergo a cesarean section in the United States, accounting for 31.9% of all deliveries.3 Leonard and colleagues4 noted that cesarean section in California between 2007 and 2014 was associated with 2.7 times the risk of severe maternal morbidity compared with vaginal delivery. In their findings, cesarean section contributed to 37% of severe maternal morbidity cases, larger than any other risk factor. Severe maternal morbidity is defined as life-threatening, unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to the mother’s health and adversely affect the health and well-being of her newborn.4,5 The Centers for Disease Control and Prevention (CDC) recognized a 200% increase in severe maternal morbidity from 1993 to 2014.6 Severe maternal morbidity cases were primarily associated with postpartum hemorrhage requiring blood transfusion, followed by hysterectomy and respiratory distress requiring ventilation support or temporary tracheostomy. According to the CDC, the rate of unexpected hysterectomy following delivery has increased by 55% from 1993 to 2014, and the rate of ventilation support or temporary tracheostomy has increased by 93% over the same time period.6 In addition to cesarean section, risk factors contributing to severe maternal morbidity include pre-pregnancy obesity, diabetes (pre-existing or gestational), hypertension (chronic or gestational), pulmonary hypertension, and pulmonary diagnoses such as chronic bronchitis, fibrosis, and asthma.