My 25th ACOG Rejection While Black Maternal Death Continues to Rise

Dear Dr. Abbasi-Hoskins:

Thanks for your response regarding my 25th rejection to become a member of ACOG’s  Medically Underserved Women’s Committee. Please be advised that I will not be submitting any future applications.

Although I have paid my annual dues for the past 25 years, I cannot guarantee that I will continue to do so in the future.

Have you noticed the dwindling number of obstetricians-gynecologists who pay their dues, especially those who look like me?

Although I originally planned to write a lengthy letter, my former high school photographer teacher (may he rest in peace) once said, “A picture is worth 1,000 words.”

The picture of this Black woman’s unassisted homebirth speaks volumes and represents our dismal failure as effective clinicians in keeping pregnant women safe and unharmed. Some Black women would rather stay home and deliver their babies in a tub without assistance than come into a hospital where they are often disrespected, ignored, and clinically mismanaged. How do we change that narrative?

This week’s JAMA opinion hits home. Medicine is an art as well as a science. Since ACOG will not allow me a membership to the Medically Underserved Committee, let me offer this advice based on my 35 years of clinical and professional experience:

  1. Stop allowing ob-gyn residents to “cut and paste” history and physicals and feign them as their own. This practice represents cheating and does not enhance their clinical acumen. How are residents supposed to learn if they use someone else’s data?
  2. Initiate mandatory competency exams regarding the diagnosis and management of preeclampsia. Some residents do NOT know how to manage preeclampsia effectively, and I have reviewed those dismal malpractice cases to prove it: The case of the late Dr. Chaniece Wallace is a prime example. The state of Indiana could use some much-needed help.
  3. Adopt the California Maternal Quality Care  Collaborative’s clinical guidelines that have proven they can reduce maternal mortality. The present ACOG clinical guidelines for the management of preeclampsia are as clear as mud, especially as it relates to patients who demonstrate preeclampsia symptoms before 39-weeks. My late residency director, Dr. Sterling Williams, former V.P. of Education at ACOG, is greatly missed. We did not have confusing clinical guidelines when he was alive.

I wish you a successful year as the new ACOG president and hope you will consider some of my recommendations.

Respectfully,

Linda Burke (formerly Burke-Galloway), MD, MS, FACOG

The U.K. Approves an Early Preeclampsia Diagnostic Test. Will the U.S. Follow?

A decision made by the British version of our NIH, the National Institute of Care and Excellence (NICE), sheds a flicker of light onto a very dark landscape regarding maternal mortality. They are authorizing the use of a blood test that will diagnose preeclampsia as early as 20 weeks. This decision is groundbreaking news and will change the landscape of how preeclampsia is currently diagnosed, treated, and hopefully save lives.

NICE is developing a draft of clinical guidelines and believes that African, Caribbean, and Asian women will benefit the most based on their history of adverse birth outcomes.

Here’s what you need to know in plain English about the test:

  • It measures Placenta Growth Factor (PIGF), which is a protein that plays a role in the development of blood vessels in the placenta
  • Women who have preeclampsia have low levels of PIGF. Low levels of PIGF means that the placenta blood vessels do not grow well

Can these tests diagnose as well as exclude preeclampsia?

Yes, according to published literature cited in the article.

Who makes these tests?

Four independent labs: one in San Diego, two in Germany, and a lab in Finland

What are the benefits of using this test for pregnant women?

The tests will make it easier for healthcare providers to diagnose preeclampsia and make fewer mistakes regarding clinical management.

Are there any economic benefits of using this test?

According to NICE literature, the saving was between 26 pounds ($34.06) to 2,896 pounds ($3,793.76) per patient.

Are there any other early diagnostic tests for preeclampsia?

Yes, there is a test using different technology that measures cell-free RNA as a means of early preeclampsia detection, according to an article published by Nature.com. However, healthcare providers do not currently use this test because it has not been approved as part of clinical guidelines.

I anxiously await the use of PIGF in mainstream obstetrics. We once thought that the adverse effects of preeclampsia stopped when the baby and placenta were delivered. However, we now know that reasoning was wrong based on the number of women who died during the postpartum period. Hopefully, with the future use of this test, women will no longer be discharged from hospitals or emergency departments prematurely. Anything that decreases maternal mortality gives me a glimmer of hope.