Strategies to Prevent Maternal Morbidity and Mortality
Scott D. Hayworth, MD, FACOG, and Donna Montalto, MPP
An increasing number of pregnant women in the United States have chronic health conditions, such as hypertension, diabetes, and chronic heart disease, which put them at a higher risk of pregnancy complications. When combined with hemorrhage, cardiovascular disease, sepsis, and other health problems, these conditions have been responsible for a large number of pregnancy-related deaths in the United States.
Many organizations are working to better understand the actual causes of maternal death. Indications from a Report from Nine Maternal Mortality Review Committees show that 70 percent of pregnancy-related deaths from hemorrhage and 68.2 percent of pregnancy-related deaths from cardiovascular and coronary conditions are preventable.1
The Centers for Disease Control and Prevention (CDC) conducts the national pregnancy-related mortality surveillance program2 with experts from the American College of Obstetricians and Gynecologists (ACOG), Society of Maternal Fetal Medicine (SMFM), Alliance for Innovation on Maternal Health (AIM), and maternal mortality review committees throughout the country. More than 50,000 women experienced severe maternal morbidity in 2014 with a mortality rate of 18.0 per 100,000.3 (Note: 2014 is the most recent year for which these data are available on a national level.) The United States is the only developed nation where the maternal death rate has been steadily rising, more than doubling over the past two decades.4
Although much is being done nationally to lower the rates of maternal morbidity and mortality, steps can be taken on local levels to support obstetrician-gynecologists, multidisciplinary clinical staff, and hospitals in lowering patient risk for maternal mortality.
The authors of the paper titled “What We Can Do about Maternal Mortality — And How to Do It Quickly,”5 provide a number of strategies that hospitals can take to prevent pregnancy-related deaths, such as:
- Focus on implementing protocols to address the main preventable causes of complications and death during pregnancy and childbirth.
- Implement staff meetings or huddles with all providers of the care team to assess and review each patient’s risk factors.
- Practice prevention efforts by simulating obstetric emergencies in the labor and delivery unit.
- Formalize existing relationships between lower-resource hospitals that transfer pregnant women who require higher levels of maternal care.
- Obtain commitment from leadership and providers across all disciplines to be ready, recognize, respond, and report outcomes when obstetric emergencies arise.
- Implement maternal safety bundles or best practices (bundles treat common obstetric complications such as hypertension, hemorrhage, and blood clots) for pregnancy-related conditions.
- Establish protocols for implementing maternal safety bundles; set the clinical standards, enforce implementation, and make compliance a top priority.
- Identify women at risk for emergencies during pregnancy and use regular briefings and simulation drills to create a “shared mental model” and train for low-probability but high-risk events.
- Allow for hospital transfer of high-risk patients and/or immediate consultation in the event of an unexpected emergency that requires care that exceeds a hospital’s resources.
- Increase collaboration among hospitals to ensure that family physicians practicing in low-resource, rural settings are trained in obstetrics. Along with training, utilize telehealth and consultation with clinics and regional hospitals to help increase access to maternity care.
Scott Hayworth, MD, FACOG, is the president and CEO of CareMount Medical, PC, the largest, independent multispecialty medical group in the United States. He is an associate dean at the Icahn School of Medicine at Mount Sinai, and he has served in multiple leadership roles for the American College of Obstetricians and Gynecologists.
Donna Montalto, MPP, is chief of staff at CareMount Medical, PC. For more than 25 years, she worked for the American College of Obstetricians and Gynecologists directing the NYS office; she has more than a decade of experience in government health policy.
Endnotes
1 Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. Retrieved from https://stacks.cdc.gov/view/cdc/51660
2 Centers for Disease Control and Prevention. (2019, June 4). Pregnancy Mortality Surveillance System. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm
3 D’Alton, M. E., Friedman, A. M., Bernstein, P. S., Haywood, L. B., Callaghan, W. M., Clark, S. L., . . . Foley, M. R. (2019, October). Putting the "M" back in maternal-fetal medicine: A 5-year report card on a collaborative effort to address maternal morbidity and mortality in the United States. American Journal of Obstetrics and Gynecology, 221(4):311-317.e1. doi: 10.1016/j.ajog.2019.02.055.
4 Hollier, L. M. (2019, March 19). The painful truth about maternal deaths. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news-insights/insights/painful-truth-about-maternal-deaths
5 The American College of Obstetricians and Gynecologists. (2018, October 31). Experts list four things any hospital can do now to prevent maternal mortality. Retrieved from https://www.acog.org/About-ACOG/News-Room/News-Releases/2018/Experts-List-Four-Things-Any-Hospital-Can-Do-Now-to-Prevent-Maternal-Mortality?IsMobileSet=false; Mann, S., Hollier, L. M., McKay, K., & Brown, H. (2018, November). What we can do about maternal mortality - and how to do it quickly. New England Journal of Medicine, 379(18):1689-1691. doi: 10.1056/NEJMp1810649
