Navya Krishna

IR pd. 2/English 11 AP
2018-2019
Compiled Annotations
Annotated Works Referenced

Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America. Bull
World Health Organ, 135. https://doi.org/10.2471/BLT.14.148627
This source says that while maternal mortality is not a problem in developed countries, it
is a problem in the United States. Statistics show that the United States has a rising rate of maternal
mortality and that many of these deaths are preventable. The author lists some factors that may be
contributing to the increasing maternal mortality in the United States, and even provides some
possible solutions. According to the article, maternal mortality in the United States is increasing
because of inconsistent obstetric practice, an increasing number of women who present at antenatal
clinics with chronic conditions which contribute to pregnancy-related complications, and the lack
of good data and analysis on maternal health outcomes.
This article contains very useful information on maternal mortality, particularly in the
United States. For a paper on decreasing maternal mortality, this article proves that increasing
maternal mortality is a problem in the United States and that there are some possible solutions.
This source, however, is more of an editorial than a scholarly article. Although, it has a credible
list of references to support the information. This source is both reliable and has credible
information on maternal mortality.
Alatawi, F. O. (2016). Heart disease during pregnancy in the KSA: A suggested plan. Journal of
Taibah University Medical Sciences, 11(5), 405-412.
https://doi.org/10.1016/j.jtumed.2016.06.004
This source provides information on both heart disease during pregnancy and maternal
mortality in the United States in comparison to other countries. It describes a study to find ways
of preventing maternal mortality and to collect data on maternal mortality. Not only does it talk
about maternal mortality, but the article discusses the types of heart disease during pregnancy. The
study also examines the fetus and assesses fetal anomalies. This article targets health-care
providers, so that they know how to deliver the proper counselling and treatment to pregnant
women with a heart disease. The study is part of an effort to reform international health-care,
particularly prenatal care.
This article can help prove that increasing maternal mortality is a problem unique only to
a few countries in the developed world, including the United States. This source is mainly about
Saudi women, but it has some valuable information on the rest of the developed world. The
statistics in this source are useful, and the study is a good model for possible action to take
regarding maternal mortality in the United States.
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A.-B., Gemmill, A., . . . Say, L. (2016).
Global, regional, and national levels and trends in maternal mortality between 1990 and
2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal
 Mortality Estimation Inter-Agency Group. The Lancet, 387(10017), 462-474.
https://doi.org/10.1016/S0140-6736(15)00838-7
This source is a collection of data about maternal mortality and pregnancy-related death,
as well as an analysis of that data. The authors of the article also analyze the data to find trends,
and to predict the rate of maternal mortality both nationally and internationally. The researchers
collected the data in the article for a larger database belonging to the UN Maternal Mortality
Estimation Inter-Agency Group. The article also makes an important distinction between maternal
death and pregnancy-related death. The purpose of this source is to convince people to take action
regarding maternal mortality.
This article has very valuable statistics about global maternal mortality, which can be
compared to the maternal mortality rate of the United States to analyze the difference in trends,
and to possibly find a reason for that difference. The information in this source is very useful for
analyzing the problem of rising maternal mortality in the United States. The article is also very
reliable because the authors provide a long list of credible sources to corroborate the information
in the article.
Ashrafi, R., & Curtis, S. L. (2017). Heart disease and pregnancy. Cardiol Ther, 157-173.
https://doi.org/10.1007/s40119-017-0096-4
This source explains the significance of cardiac disease during both pregnancy and the
post-partum period. It has both statistics on heart disease during pregnancy and possible solutions
for the high maternal mortality. The article also explains some of the physiological changes of the
cardiovascular system due to pregnancy. This article is mainly aimed at cardiologists and
recommends more pre-pregnancy counselling, as well as specialist multi-disciplinary care. The
authors of the article also advise cardiologists on how to handle cardiovascular complications
during labor and delivery. The article has guidelines for evaluation of cardiovascular disease
during pregnancy and post-partum.
This article is especially useful for research on heart disease during pregnancy and
postpartum, because that is its focus. The researchers also give detailed explanations of
physiological changes and some solutions. The authors give a long list of references to corroborate
the information in the article and it was published in a peer-reviewed journal, so it is credible.
Balint, O. H., Siu, S. C., Mason, J., Grewal, J., Wald, R., Oechslin, E. N., . . . Silversides, C. K.
(2010). Cardiac outcomes after pregnancy in women with congenital heart disease. Heart,
96(20), 1656-1661. https://doi.org/10.1136/hrt.2010.202838
This source is a study of the effectiveness of the cardiovascular system postpartum for
women with a congenital heart disease. This study was conducted because no previous studies had
been conducted on the specific issue addressed in this study - late cardiac events after pregnancy
in women of child-bearing age with congenital heart disease. The results of the study were that
while mortality was rare, about 1/10 of the pregnancy were followed by a late cardiac event, with
arrhythmias and heart failure being the most common. The researchers also found certain factors
that increased the women's risk of a late cardiac event. Pregnancy can mask some of the symptoms
of congenital heart disease, which can make them hard to catch.
This article provides a description of the symptoms of congenital heart disease, which is
very useful for differentiating between the symptoms of pregnancy and the symptoms of heart
failure. The authors also provide a list of solutions for certain cardiovascular problems, which is
useful to know for educating physicians on the difference between pregnancy and heart failure
symptoms. The article includes a long list of sources to prove that the information is reliable.
Brickner, B. (2018, January 11). Cardiovascular morbidity and mortality in pregnancy. Retrieved
January 17, 2019, from Contemporary Ob/Gyn website:
http://www.contemporaryobgyn.net/article/cardiovascular-morbidity-and-mortality-
pregnancy
This source has information on cardiovascular changes during pregnancy and congenital
heart defects that are worsened by pregnancy. The website article has an explanation of all the
possible cardiovascular problems that could occur during pregnancy, including the congenital
heart diseases, heart defects, valvular heart diseases, prosthetic valve disease, cardiomyopathy,
coronary artery disease, aortic dissection and pulmonary hypertension. It also talks about how
pregnancy affects each cardiovascular problem and the recommended course of action for each
problem. The author of the website article also gives some ways to predict a woman’s risk of
cardiovascular disease. The website article has a section on the coordination of care for pregnant
women with a heart condition at the end.
This article has very useful information on cardiovascular problems during pregnancy and
on the best care for each problem. The section about coordination of care is helpful for educating
physicians on the best care for cardiovascular disease in pregnant women. The author of the article
is a credible source, so the information is reliable.
Campbell, T. A., & Sanson, T. G. (2009). Cardiac arrest and pregnancy. Journal of Emergencies,
Trauma, and Shock, 2(1). https://doi.org/10.4103/0974-2700.43586
This source is a website article with a detailed explanation of the anatomical changes of
the heart due to pregnancy. It also talks about preventive measures that can be taken to preventive
measures that can be taken to stop a cardiac event from even taking place. The article gives the
effects of a cardiovascular disease on the fetus as well and gives some ways of safely monitoring
the fetus. The authors of the article also include a chart of the causes of maternal arrest. The article
gives ways of resuscitating women after they have had a cardiac event, but it recommends that
preventive measures be taken instead.
This article is very useful for understanding the anatomical changes of the cardiovascular
system during pregnancy and for understanding how to prevent maternal mortality after a woman
has had a cardiovascular event. However, the author advocates for preemptive care instead, which
is reliable support for the education of physicians in the diagnosis and prompt assessment of
cardiovascular disease in pregnant and postpartum women.
Chung, E., & Leinwand, L. A. (2014). Pregnancy as a cardiac stress model. Cardiovascular
Research, 101(4), 561-570. https://doi.org/10.1093/cvr/cvu013
This source talks about the anatomical stress that pregnancy puts on the heart and some of
the cardiovascular problems that could occur because of pregnancy. The article says that some
women could have a cardiac event due to pregnancy, but without having any history of
cardiovascular disease. It goes in depth into the hormonal changes of pregnancy and how they
affect the heart, more specifically how they can cause issues with the heart. There are both
physiological and pathological changes that occur in the heart during pregnancy. The authors also
mention genetic factors that affect the heart during pregnancy, and how certain risks are different
from others depending on the woman.
This article proves that cardiovascular events are a high risk for pregnant women, even
ones with no history of cardiovascular disease. It gives specific examples of possible problems to
pay attention for in pregnant women, especially regarding the heart. The source is credible because
it was published in a peer-reviewed journal and the authors are experts in the field.
Collins, P., Abdul-Kadir, R., & Thachil, J. (2015). Management of coagulopathy associated with
postpartum hemorrhage: Guidance from the SSC of the ISTH. Journal of Thrombosis and
Haemostasis, 14(1), 205-210. https://doi.org/10.1111/jth.13174
This source focuses on one of the problems with postpartum hemorrhage, coagulopathy.
The article talks about the physiological reasons for postpartum hemorrhage and coagulopathy,
such as increased levels of procoagulant factors and decreases in anticoagulants. The authors give
three possible methods of monitoring hemostasis: clinical observation; laboratory-based PT/aPPT,
Clauss fibrinogen and platelet count; and point of care testing (POCT). They all seem to be equally
effective and can even be used simultaneously, along with some other treatments in the article.
The source concludes that expert opinion will vary and that more clinical trials should be
conducted.
This article is beneficial for collecting information on cardiovascular disease during the
postpartum period. Physicians should know the indicators of postpartum hemorrhage and
coagulopathy. The source is reliable because it was published by the International Society on
Thrombosis and Haemostasis and the authors are experts in the field.
Cooper, R., Cohen, M., Tilson, E. C., & Lovette, B. (Presenters). (2018, October). Annual
Report to the North Carolina Medical Society [Reading].
This source is a report to the North Carolina Medical Society. It addresses a wide variety of
health-related problems in the state of North Carolina, for example maternal and infant health,
chronic disease and substance abuse. The source contains data on both the prevalence and impact
of each problem and possible solutions. The data are collected by the government of North
Carolina for the purpose of examining the overall health of the citizens of North Carolina. The
authors also propose programs to alleviate the problems discussed in the report. In addition, the
source includes programs that are currently implemented and has data on the change of the North
Carolina population over time in relation to many of the problems.
This article is very beneficial for an examination of maternal health in the United States and
provides examples of initiatives to address the issue. The data in this source can be compared to
maternal mortality data in other states, in addition to other countries, to draw conclusions about
the United States as a whole. The source is somewhat reliable because it is a government
document and the data are collected by the state government, so there is possible bias in the
collection and analysis of the data.
Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2015).
Pregnancy-related mortality in the United States, 2006–2010. Obstetrics & Gynecology,
125(1), 5-12. https://doi.org/10.1097/AOG.0000000000000564
This source is a collection of data and the analysis of that data. The researchers examined
pregnancy-related mortality in the United States. They mainly used data from the Center for
Disease Control and Prevention’s Pregnancy Mortality Surveillance System. The researchers
found that there is an increasing pattern in pregnancy-related mortality in the United States. A
contributing factor is that more pregnant women in the United States have chronic health
conditions such as hypertension, diabetes, chronic heart disease and obesity. They also addressed
the three most common preventable causes of maternal death and disease: obstetric hemorrhage,
hypertensive disorders of pregnancy, and venous thromboembolism.
This article has valuable data proving that maternal mortality, particularly from
cardiovascular disease, is a problem in the United States. The researchers have also proven that
the high maternal mortality in the United States is preventable. The information in the article is
also reliable because it can be corroborated by the long list of sources, and because the authors are
experts in the field.
Dijkman, A., Huisman, C. M.A., Smit, M., Schutte, J. M., Zwart, J. J., van Roosmalen, J. J., &
Oepkes, D. (2009). Cardiac arrest in pregnancy: Increasing use of perimortem caesarean
section due to emergency skills training? BJOG an International Journal of Obstetrics
and Gynaecology, 117(3), 282-287. https://doi.org/10.1111/j.1471-0528.2009.02461.x
This source is a study to determine the effectiveness of perimortem caesarean section as a
means of decreasing maternal mortality and morbidity. The article says that emptying the uterus
removes aortocaval compression, which increases the likelihood of maternal survival. The
researchers found that in theory, decreasing the time interval between cardiac arrest and caesarean
section increased the rate of maternal survival. However, their data found a higher fatality rate of
perimortem caesarean section in comparison to the fatality rate for resuscitation in pregnancy
without perimortem caesarean section. The authors say that this is because perimortem caesarean
section should be performed within 5 minutes of cardiac arrest, which wasn’t done in the study.
This article highlights one method of decreasing maternal mortality. However, the
implementation of this solution is difficult and a bit unrealistic because it is so specific. If the exact
requirements are not met, it can actually increase maternal mortality. The information, however,
is reliable because the article was published in a peer-reviewed journal and the authors are experts
in the field.
Flo, K., Wilsgaard, T., Vårtun, Å., & Acharya, G. (2010). A longitudinal study of the
relationship between maternal cardiac output measured by impedance cardiography and
uterine artery blood flow in the second half of pregnancy. BJOG an International Journal
of Obstetrics and Gynaecology, 117(7), 837-844. https://doi.org/10.1111/j.1471-
0528.2010.02548.x
This source is a study measuring the relationship between maternal cardiac output and
uterine blood flow. The researchers conducted this study because there were no previous published
studies on this specific subject. They found that the most significant increase in cardiac output
occurs during the first half of pregnancy because of an increase in stroke volume. They also found
that cardiac output also increases during the second half of pregnancy, although it’s less than the
first half of pregnancy, because of an increase in heart rate. The article concludes with the claim
that maternal cardiac output distributed to the uterine circulation doubles.
This article proves that there are cardiac changes during pregnancy and that pregnancy
causes stress on the heart. This stress can lead to cardiovascular problems, which can prove that
pregnancy can cause cardiovascular problems. The information in the article is reliable because it
was published in a peer-reviewed journal and the authors are experts in the field.
Hameed, A., Foster, E., Main, E., Khandelwal, A., & Lawton, E. (2017). Cardiovascular disease
assessment in pregnant and postpartum women. Cardiovascular Disease Pregnancy and
Postpartum Toolkit, 7-12.
This source is a part of the Cardiovascular Disease in Pregnancy and Postpartum Toolkit
that was done in California to decrease maternal mortality in California. The toolkit advocates for
improved clinical assessment and management strategies based on risk factors and presenting signs
and symptoms. The article gives a chart of red flags and symptoms of cardiovascular disease to
look out for so that earlier assessments of cardiovascular disease can be made. The toolkit takes
into account certain factors such as personal history of cardiovascular disease, age and some other
factors. The toolkit also gives a clear and straightforward graphic to tell the intended audience
which course of action they should pursue based on certain symptoms.
This article provides the basis for efforts to decrease maternal mortality nationwide. The
toolkit was successful, so it is a good model for other efforts to achieve the same goal. The project
was run by doctors, all experts in their field, so it is reliable, and the whole project was reviewed
by groups of experts in the field before it was even carried out.
Hameed, A. B., Lawton, E. S., McCain, C. L., Morton, C. H., Mitchell, C., Main, E. K.,
& Foster, E. (2015). Pregnancy-related cardiovascular deaths in California: Beyond peripartum
cardiomyopathy. American Journal of Obstetrics & Gynecology, 213(3), 1-10.
https://doi.org/10.1016/j.ajog.2015.05.008
This source is a journal article written about the California Cardiovascular Disease in
Pregnancy and Postpartum Toolkit. The authors of the article, who are also the researchers running
the toolkit project, took notice of the high maternal mortality rate in the United States and decided
to address it, specifically in California. The researchers found that almost half of the cardiovascular
disease deaths in the project would not have been identified as pregnancy-related without the
project. Their results showed that the project actually decreased maternal mortality in California.
The researchers identified three subpopulations of fatal pregnancy-related cardiovascular disease:
women with multiple risk factors and no prior cardiovascular diagnosis; women with no specific
risk factors who developed peripartum cardiomyopathy; and women with preexisting
cardiovascular disease at the time of presentation in pregnancy.
This article provides valuable information about the toolkit and the field of maternal
mortality from cardiovascular disease. It is very valuable for any future efforts to conduct a similar
project to reduce maternal mortality, but in another part of the country. The researchers are also
very knowledgeable about the subject because they ran the project themselves and they did their
own research for the project.
Hogan, L., Rutherford, B. K., & Neall, R. R. (Presenters). (n.d.). Maryland maternal mortality
review 2017 annual report [Reading]
This source is a report passed by the state government of Maryland to collect data on
maternal mortality in Maryland. The report has data and some recommendations for decreasing
the maternal mortality rate. The report finds that although the maternal mortality rate has increased
between 2006-2010 and 2011-2015, it was above the United States maternal mortality rate in 2006-
2010 and with was below the United States maternal mortality rate in 2011-2015. The report also
has a collection of cases that were used to collect the data, and the cases are organized into certain
categories that align with risk factors for maternal mortality. The recommendations focus on
maternal mortality from drug consumption.
This article has information on maternal mortality, especially statistics specific to
Maryland. This report is particularly valuable for an effort to decrease maternal mortality in
Maryland. Although the recommendations in the report are more about drug consumption, the
information can help with any maternal mortality project specific to Maryland. The source is also
reliable because it is a government project and the authors are high-level government officials in
the Maryland state government.
H.R.1318 - Preventing Maternal Deaths Act of 2018. (2018, December 21). Retrieved January
14, 2019, from congress.gov website: https://www.congress.gov/bill/115th-
congress/house-bill/1318/text
This source is a bill passed by Congress in 2018. The bill was passed as a national effort to
reduce maternal mortality in the United States. It mainly talks about supporting states in their own
projects to reduce maternal mortality. The national government wants to decrease certain societal
factors that contribute to the high rate of maternal mortality in the United States. Congress mostly
mentions data collection and forming maternal mortality review committees in states. The bill also
mentions identifying and trying to eliminate risk factors for maternal mortality.
This article shows a national concern for the high rate of maternal mortality in the United
States and a push to decrease it. It also proves that maternal mortality is a problem prevalent
enough to warrant national attention. The source is also credible because it is from the website of
Congress, and because it is the actual bill passed by Congress in 2018.
MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Is the United States maternal
mortality rate increasing? Disentangling trends from measurement issues. Obstet
Gynecol, 128(3), 447-455. https://doi.org/10.1097/AOG.0000000000001556
This source is an article analyzing the data about maternal mortality in the United States.
Although the United Nations Millennium Development Goal for reducing maternal mortality was
75%, statistics show that maternal mortality in the United States is actually increasing. The authors
used data from the Centers for Disease Control and Prevention’s National Center for Health
Statistics. They also relied on reporting from each state, even though each state collected their data
somewhat differently. Because of that, they had to apply correction factors to the data they used.
The article also mentions that maternal mortality in California declined after the toolkit project,
but that maternal mortality increased in the United States overall.
This article provided some valuable data both on maternal mortality in the United States
and in individual states. Because it is data intensive, it can be used to prove that maternal mortality
in the United States is increasing to a point where it should be addressed. The source is also reliable
because it was peer-reviewed by the journal and the authors are experts in the field, and they have
a list of sources to corroborate the information.
Redshaw, M., & Henderson, J. (Presenters). (2015, February). Safely delivered: A national
survey of women's experience of maternity care 2014. Reading presented at the National
Perinatal Epidemiology Unit, University of Oxford, UK.
This document is an analysis of a survey conducted in the UK about women’s experience in the
health care system. The source focuses on prenatal care and the accessibility of health care to
women in the antenatal, labor and postnatal stages of pregnancy. Many of women in the survey
reported that they saw either a physician or a midwife at least once before labor. The authors also
noted the changes in the data over time in the areas of accessibility of antenatal care, labor and
birth care, postnatal care, and perceptions of care. In addition, the document addresses the
difference in experience for minority ethnic women, minority ethnic women living outside of the
UK, single parents, and women living in disadvantaged areas. The researchers conclude that the
responses and experiences of the women varied greatly depending on the individual.
This source is beneficial for research on methods of increasing accessibility to prenatal care. The
data in the document can be used to indicate the effects of certain measures that were taken in
order to improve accessibility and perception of care for pregnant women. This source is reliable
because it was delivered to a group of credible and knowledgeable professionals, and the data
were collected by a reliable source.
Roos-Hesselink, J. W., & Stein, J. I. (2017). Pregnancy and cardiac disease. Rev Esp Cardiol,
70(2), 78-80. https://doi.org/10.1016/j.rec.2016.08.002
This source discusses cardiovascular diseases during pregnancy and certain changes that
occur during pregnancy that may lead to those cardiovascular diseases. The article mentions that
a major reason for the increase in cardiovascular disease during pregnancy is the increase in
women with congenital heart disease. The authors recommend that women with congenital heart
disease should be seen and counselled by well-trained specialists before getting pregnant. They
also recommend collecting more data on maternal mortality.
This article has lots of information on cardiovascular disease during pregnancy. It is also
very useful for collecting analysis of maternal mortality data in the United States. The source is
also very reliable because it was published in a peer-reviewed journal and the authors are experts
in the field.
Ruys, T. P. E., Roos-Hesselink, J. W., Hall, R., Subirana-Doménech, M. T., Grando-Ting, J.,
Estensen, M., . . . Pieper, P. G. (2013). Heart failure in pregnant women with cardiac
disease: Data from the ROPAC. Heart, 100(3), 231-238. https://doi.org/10.1136/heartjnl-
2013-304888231
This source is a study to figure out the prevalence of heart disease during pregnancy. It
talks about the effects of pregnancy on the heart. The article also mentions the periods during
pregnancy at which women are at the highest risk for cardiovascular disease. The authors also
mention the predictors of heart failure. They also found that the timing of heart disease was
dependent on the underlying cardiac diagnosis, with the heart failure in the second trimester
occurring mainly in patients with shunt lesions.
This article has some information on heart disease during pregnancy, which is useful for
research on maternal mortality from cardiovascular disease. The source is also reliable because the
article was published in a peer-reviewed journal and the authors are experts in the field.
Zentner, D., du Plessis, M., Brennecke, S., Wong, J., Grigg, L., & Harrap, S. B. (2009).
Deterioration in cardiac systolic and diastolic function late in normal human pregnancy.
Clinical Science, 116(7), 599-606. https://doi.org/10.1042/CS20080142
This source is a study to measure cardiac systolic and diastolic function during pregnancy.
It says that previous studies have shown increases, no change and deteriorations in ejection fraction
during pregnancy. The researchers collected data on cardiac output during pregnancy, as well as
on systolic and diastolic function. They found that in the basal resting state, there is a deterioration
in both contractile and relaxation capacity of the myocardium during pregnancy. There is a
deterioration in heart function due to pregnancy.
This article proves that pregnancy causes heart problems, which can eventually lead to
mortality. It is helpful to know the anatomical changes of the heart during pregnancy to figure
out how to decrease maternal mortality from cardiovascular disease. The source is also reliable
because it was published in a peer-reviewed journal and the authors are experts in their field,
although the source is not very current.