Strategies to Prevent Maternal Morbidity and Mortality
An increasing number of pregnant women in the United States have chronic health conditions — such as hypertension, diabetes, and chronic heart disease — that put them at higher risk for 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.
The Centers for Disease Control and Prevention (CDC) conducts the national pregnancy-related mortality surveillance program to better understand the risk factors for and causes of pregnancy-related deaths in the United States. CDC data show that the pregnancy-related mortality ratio in the United States in 2019 was 17.6 per 100,000 live births.1 Additionally, severe maternal morbidity is estimated to affect more than 50,000 patients annually.2 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.3
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 patients' risk for poor maternal outcomes. Hospitals can implement various strategies to prevent pregnancy-related deaths and complications, such as:
- Focusing on developing protocols to address the main preventable causes of complications and death during pregnancy and childbirth.
- Implementing staff meetings or huddles with all providers of the care team to assess and review each patient’s risk factors.
- Practicing prevention efforts by simulating obstetric emergencies in the labor and delivery unit.
- Formalizing existing relationships between lower-resource and higher-resource hospitals to facilitate the transfer of pregnant women who require higher levels of maternal care.
- Obtaining commitment from leadership and providers across all disciplines to be ready, recognize, respond, and report outcomes when obstetric emergencies arise.
- Implementing maternal safety bundles or best practices (bundles treat common obstetric complications such as hypertension, hemorrhage, and blood clots) for pregnancy-related conditions.
- Establishing protocols related to maternal safety bundles, such as setting clinical standards, enforcing implementation, and making compliance a top priority.
- Identifying women at risk for emergencies during pregnancy and using regular briefings and simulation drills to create a “shared mental model” and train for low-probability but high-risk events.
- Allowing 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.
- Increasing 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.4
For more information related to improving maternal health, see MedPro’s Risk Resources: Maternal Morbidity and Mortality.
Endnotes
1 Centers for Disease Control and Prevention. (2023, March 23 [last updated]). Pregnancy Mortality Surveillance System. Retrieved from www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
2 Fink, D. A., Kilday, D., Cao, Z., Larson, K., Smith, A., Lipkin, C., . . . Rosenthal, N. (2023). Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. JAMA Network Open, 6(6), e2317641. doi: https://doi.org/10.1001/jamanetworkopen.2023.17641
3 Hollier, L. M. (2019, March 19). The painful truth about maternal deaths. Association of American Medical Colleges. Retrieved from www.aamc.org/news-insights/insights/painful-truth-about-maternal-deaths
4 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 www.acog.org/news/news-releases/2018/10/experts-list-four-things-any-hospital-can-do-now-to-prevent-maternal-mortality; 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
