PRIHSM
Stanford University
The Center for Preventing Inequities in Hemorrhage-related Severe Maternal Morbidity (PRIHSM) at Stanford University aims to reduce postpartum hemorrhage in California and beyond.
Stanford University
Contact
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Co-Principal Investigator: Dr. Yasser Y. El-Sayed
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Co-Principal Investigator: Dr. Suzan L. Carmichael
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Co-Principal Investigator: Dr. Deirdre Lyell
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Co-Principal Investigator: Dr. Elliott Main
At a Glance
2
Research Projects
7+
Community Partners
Research Topics- Inequities in postpartum hemorrhage
- Iron deficiency anemia prevention
- Cesarean-associated hemorrhage
Status
Research activities started
Overarching Aims
Reduce antenatal iron deficiency anemia by developing, testing, implementing, and disseminating a patient informed Anemia Prevention Toolkit which will standardize the evaluation, diagnosis, and treatment of iron deficiency anemia and reduce racial and ethnic disparities at birth admission.
Reduce disparities in rates of primary cesarean birth and cesarean-linked postpartum hemorrhage by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide.
Provide infrastructure and conceptual grounding to ensure that PRIHSM’s research is centered on principles of community-engaged research and health equity, and nurture partnerships with patients, stakeholders, and community-based organizations that represent people affected by the study outcomes.
Build a community of trainees and a set of resources that enhance the pipeline and diversity of maternal health researchers and practitioners.
Research Project Details
Patient-Centered Community & Clinical Approaches to Reduce Racial Disparities at Birth by Preventing Anemia
This study aims to reduce antenatal iron deficiency anemia by developing, testing, implementing, and disseminating a patient informed Anemia Prevention Toolkit which will standardize the evaluation, diagnosis, and treatment of iron deficiency anemia and reduce the prevalence of racial and ethnic disparities at birth admission. The Anemia Prevention Toolkit will be piloted in 8 hospitals, then disseminated across hospitals in California, Oregon, and Washington.
Centering Birth Equity in Cesarean Delivery
This study aims to reduce disparities in rates of primary cesarean birth and cesarean-linked postpartum hemorrhage by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide. The maternal equity guide will be piloted in 8 hospitals, then disseminated across hospitals in California, Oregon, and Washington.
Key Maternal Health Indicators: California
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419,104
live births in 2022 1
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31.0%
of births were cesarean deliveries 1
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9.1%
of births were preterm 1
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40.3%
of deliveries were covered by Medicaid 1
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1,123
birthing people with life-threatening complications per every 100,000 births 2
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18.6
birthing people die from pregnancy complications per every 100,000 births 3
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3.6x
more Black birthing people die from pregnancy complications than White birthing people 3
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Top-3 causes
of pregnancy-related deaths: cardiovascular disease, hemorrhage, and sepsis 3
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6.4%
of women are without a birthing hospital within 30 minutes 4
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83.4%
of birthing people start prenatal care in the 1st trimester 1
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21.5%
of Black pregnant people experienced antepartum anemia, a higher proportion than any other racial group 5
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21%
of severe maternal morbidity events are contributed to by antepartum anemia 5
Partner Organizations
- BLACK (Belonging, Love, Affinity, Community, Kinship) Wellness and Prosperity Center
- California Maternal Quality Care Collaborative
- Center and project specific Community Advisory Boards
- GO MOMS (Global Outreach- Mobile Obstetrics Medical Simulation)
- San Mateo County Health Obstetrics
- Stanford Children’s Health/Lucile Packard Children’s Hospital
- University of Alabama at Birmingham (UAB) Center for Women’s Reproductive Health
"We look forward to working with NICHD and the NIH IMPROVE initiative to help reduce one of the leading causes of maternal mortality and severe maternal morbidity: postpartum hemorrhage. We are also committed to being leaders in reducing maternal health inequities through our Center’s research projects and training initiatives, and through deepening ties to our local and national communities."
References
- Data are from 2022 live births occurring within the US to US residents. Cesarean deliveries are the percentage of live births where the final route and method of delivery was cesarean. Preterm births are the percentage of live births where the gestational age at birth was less than 37 weeks. Medicaid coverage is the percentage of live births where the source of payment for the delivery hospitalization was Medicaid. Prenatal care in the 1st trimester is the percentage of live births where the first prenatal appointment occurred between the 1st and 3rd month of pregnancy.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Natality on CDC WONDER Online Database. - Life threatening complications are deliveries with a diagnosis or procedure code indicating severe maternal morbidity. Information reported for 2021.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases 2010 to 2021. - Number of deaths is based on pregnancy-related deaths in 2020. The difference in rate of pregnancy-related deaths between Black and White women birthing peopleand top 3 causes of pregnancy-related deaths are based on deaths in 2012-2020. Pregnancy-related deaths include deaths during or within a year of pregnancy from causes related to or aggravated by the pregnancy or its management.
Source: California Department of Public Health. Pregnancy Related Mortality in CA, CA-PMSS, 2012-2020. - March of Dimes Maternity Care Deserts Report 2023.
- Igbinosa II, Leonard SA, Noelette F, Davies-Balch S, Carmichael SL, Main E, Lyell DJ. Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity. Obstet Gynecol. 2023 Oct 1;142(4):845-854. Access at: https://pubmed.ncbi.nlm.nih.gov/37678935/