- Joined
- Jul 12, 2012
- Messages
- 1,631
- Reaction score
- 1,465
im a med student and were learning about this in class but i dont understand how we could have worse outcomes compared to so many other less advanced countries? thanks for insights
Europeans smoke like chimneys. Does that matter?we're a fatter people.
could that have something to do with it?
Europeans smoke like chimneys. Does that matter?
im a med student and were learning about this in class but i dont understand how we could have worse outcomes compared to so many other less advanced countries? thanks for insights
I still take OB call for the health system I am employed at so I do cover unassigned patients. Here is a list of patients off the top of my head that will mess with our statistics.
Patient from an Asian country came to US specifically to deliver. She had 2 prior C sections. Came to the hospital with severe abdominal pain at 38 weeks.
Had a ruptured uterus with a dead baby. We saved her life. Of course it is a fetal demise and we will get dinged for it.
Numerous patients from south of the border (Mexico, El Salvador, Guatamala etc) with no or limited prenatal care dropping in to the local hospital with major obstetric complications (pre eclampsia, diabetes, etc)
Patient with limited pre natal care and meth use with a placental abruption and fetal demise.
As alluded to earlier, patients are getting fatter/sicker/older which does not bode well for pregnancy outcomes.
I had a 22 year old patient who was pushing 300lbs! This is not unusual either. Obese patients have worse obstetric outcomes, increased rates of fetal demise, increased rates of birth defects etc but we still get dinged for it.
I delivered a patient who went into spontaneous labor at 23 weeks of a ~400gm infant. They wanted everything done so the neonatologist and team was present for deliver and proceeded with an aggressive resuscitation. Baby was alive last I checked but it doesn't look good.
So patients with limited or no prenatal care come to the US specifically to deliver and some will have bad outcomes that we basically absorb. I can guarantee you no one from the US is going to China/Jpaan/Mexico/France etc to deliver.
Unless you can pull out some statistic that tells me that these people from other countries delivering their babies in the US makes up a significant portion of the deliveries every year (and that they have a significantly higher complication rate than our own obese, relatively advanced maternal age, multiple comorbid population), that shouldn’t even be put out there as an issue.
I too can give you plenty of anecdotal examples of perfectly healthy non-citizen patients as well who had perfectly healthy babies (especially in the Hispanic population actually).
Just as a point of clarification, stillbirth and fetal demise don’t count in infant mortality rate even in the US. That is a separate metric.