Maternal mortality coverage – beyond 2018

In January 2018, Contemporary OB/GYN launched a year-long series to bring maternal mortality to the forefront of our coverage. Under the guidance of Editor-in-Chief Charles J. Lockwood, MD, MHCM, and the two of us, as Series Editor (CMZ) and Executive Editor (LMW), respectively, caregivers were alerted to this crisis, terminology was defined and clarified, and the problem dissected one layer at a time. 

We exposed etiologies through detailed topical presentations, providing cutting-edge pathophysiology as well as algorithms for caregivers to enhance safety. We provided resource lists that expanded on the information we presented, and we provided resource guides to educate patients and their families on crucial information. And we presented articles on the tragedy of maternal loss and how it affects families left behind as well as the physicians who are also touched by the loss.

We are proud of this year’s work, but also aware that the crisis of maternal morbidity and mortality can’t be covered completely within the span of 12 issues. We owe it to our mothers to keep going. Therefore, Contemporary OB/GYN is committing to continued coverage of maternal mortality into the new year and beyond, as significant developments arise. 

Solutions to the maternal mortality crisis require implementation of strategies at every level, starting with ob/gyns as individuals and as members of the local care community. Staying up to date with the latest research on maternal mortality and morbidity and being aware of and adhering to best practices are a start. Supporting institutions in their implementation of bundles, toolkits, protocols and guidelines, and participating in multidisciplinary drills, reviews, and training sessions in emergency, labor and delivery, and postpartum units would be even better. Ob/gyns who want to take an even larger role can initiate case studies of their local patient population and coordinate with local chapters of the Maternal Mortality Review Committees (MMRCs) and other agencies. 

As practitioners, we should also be aware of other health care models that have successfully lowered maternal mortality in other countries. The UK success story is worth examining in more detail as summarized by Knight and Tuffnell.¹ The UK reduced maternal mortality from 14/100,000 maternities in 2004 to 8.5/100,000 maternities in 2014. While a direct cause and effect cannot be proven, the UK’s success in reducing maternal mortality appears to be linked to detailed surveillance and structured root cause analysis (RCA) case reviews performed by the Confidential Enquiry into Maternal Deaths (CEMD), now in its 60th year of existence. The current project to halve maternal deaths is a pattern that other countries, including our own, can emulate.

As we have learned, publication of a clinical pathway alone does not ensure adherence at the bedside, either in a particular care setting or in every state in the country. Commitment to lowering maternal mortality will require dedication of practitioners as well as relentless engagement of healthcare systems that value individuality and embrace our diversity as a nation. By working together, we can develop and implement the standards necessary to safeguard the lives of our mothers, one life at a time.  

References:

1. Knight M, Tuffnell D. A view from the UK: the UK and Ireland Confidential Enquiry into Maternal Deaths and Morbidity. Clin Obstet Gynecol. 2018 Jun;61(2):347-358.