This issue of The Journal of Perinatal & Neonatal Nursing contains a variety of articles that focus on select maternal medical conditions that contribute to severe maternal morbidity and mortality. In recent years, in the United States (US), there has been an increase in the number of pregnancies adversely impacted by preexisting as well as later-onset maternal medical conditions, particularly hypertension, cardiac disease, and sepsis. The recognition that a substantial proportion of severe morbidity is preventable has led to collaborative, multidisciplinary, national initiatives focused on continued research and recommendations for optimal care practices related to the most common causes of maternal compromise.
The lead article of this edition is "Maternal Morbidity and Mortality: Identifying Opportunities to Improve Clinical Outcomes." In it, Witcher and Sisson outline current data related to maternal mortality in the United States and identify several practice strategies aimed at preventing maternal morbidity and death.
In their discussion of "Obstetric Sepsis: Focus on the Three-Hour Bundle," Brown and Arafeh stress that perinatal infection leading to sepsis in the US obstetrical population continues to be a significant contributor to maternal morbidity and mortality. They describe, in detail, utilization of the Surviving Sepsis Campaign bundles as essential for the early recognition and timely management of sepsis and then provide a comprehensive plan for its implementation.
Cardiomyopathy during pregnancy is an uncommon but potentially catastrophic medical complication that is one of the most common causes of severe maternal heart failure or death. The article "Cardiomyopathy During Pregnancy" by Troiano provides an overview of the pathophysiology of the disease and its peripartum management. Women with preexisting cardiomyopathy, such as dilated or hypertrophic cardiomyopathy, who are followed closely during pregnancy, often tolerate both pregnancy and birth well. In contrast, risk factors for adverse outcomes include maternal functional status at baseline, severity of systolic dysfunction or outflow tract gradient, or history of a cardiac event such as arrhythmia or stroke. The multidisciplinary team that is often necessary for optimal outcomes includes nurses, obstetricians, cardiologists, neonatologists, anesthesia personnel, and cardiac surgeons.
"Multisystem Effects of Hypertensive Disorders of Pregnancy: A Comprehensive Review" is the last article of this series. In it, Witcher, Chez, and Baird address the well-established risk factors for adverse perinatal outcomes associated with hypertension in pregnancy. Hypertensive disorders of pregnancy are categorized on the basis of their etiology and the timing of system onset before or during pregnancy and include preeclampsia, gestational hypertension, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Each of these clinical entities is addressed in detail.
It remains true that most pregnant women are without identified medical conditions and proceed through pregnancy, labor, birth, and the postpartum period without incident. However, for women with potentially lethal medical conditions, especially those that have been described in this issue, severe maternal morbidity and mortality remain unacceptably high.
The 3 articles in the neonatal section of this issue of the journal focus on contemporary topics that are very relevant for practicing neonatal nurses because they address hot topics.
Asmerom, Crowe, and Marin present the CE article on probiotic, prebiotic, and synbiotic preparations. These preparations may have protective properties for the immature intestine by altering the microbial environment, enhancing immune response, and maturing the intestinal barrier, potentially offering a strategy to prevent development of necrotizing enterocolitis.
Supporting neonates in managing painful procedures the focus of the article by Obeidat and Shuriquie. They present the results of a randomized clinical trial comparing the interventions of breast-feeding with maternal holding and maternal holding without breast-feeding in relieving painful responses during heel lance blood drawing. Pain scores were significantly lower in the breast-feeding newborns.
Smith and her interprofessional colleagues present implementation of hypothermia for the treatment of hypoxic-ischemic encephalopathy to exemplify improvement science in translating evidence into practice. Their article highlights some of the challenges in attempting to implement evidence-based standards of care.
Our 3 columnists, Drs Blackburn, Gregory, and Verklan, once again provide substantive and meaningful pieces for your thoughtful consideration and use.
-Suzanne McMurtry Baird, DNP, RN
-Bonnie Flood Chez, MSN, RNC
Perinatal Guest Editors
-Susan Bakewell-Sachs, PhD, RN, PNP-BC, FAAN
Neonatal Editor