What can you do to reduce maternal severe morbidity and mortality?

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There are a number of things ob/gyns can do to take an active role in reducing maternal severe morbidity and mortality at their own institutions and practices, including:

Review all maternal deaths at your institution.¹

Review all cases of severe maternal morbidity (ICU admissions and/or transfusions of 4 or more units of red blood cells.²

Implement bundles: hemorrhage, hypertension, etc.³

Have all perinatal staff take implicit bias training.⁶

Utilize toolkits.⁴

Have a massive transfusion protocol and hemorrhage kit on L+D.⁵

Have clear severe hypertension treatment guidelines posted and treat acute severe hypertension within 30 minutes.¹²

^{Screen for VTE risk and treat appropriately.7}

Debrief after each adverse event.⁸

Participate in Levels of Maternal Care designation.⁹

Participate in multidisciplinary simulations in the L+D unit and in testing areas.¹⁰

Expand community outreach for better access for Medicaid and others.¹¹

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References

1. Berg C, Danel I, Atrash H, Zane S, Bartlett L.Strategies to reduce pregnancy-related deaths:from identification and review to action. Centers for Disease Control and Prevention. 2001. https://stacks.cdc.gov/view/cdc/6537

2. ACOG, SMFM; Kilpatrick SJ, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol. 2016;215:B17-22.

3. a. Burgansky A, Montalto D, Siddiqui NA.The safe motherhood initiative: the development and implementation of standardized obstetric care bundles in New York. Semin Perinatol. 2016;40(2):124-131. b. http://safehealthcareforeverywoman.org/

4. a. Main EK, Cape V, Abreo A, et al. Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. Am J Obstet Gynecol. 2017;216(3):298.e1-298.e11. b. CMQCC.org

5. a. ACOG. Postpartum hemorrhage. Practice Bulletin. 2017;183. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage b. http://safehealthcareforeverywoman.org/ c. Blood product replacement: obstetric hemorrhage. CMQCC.org.

6. Rogers, VL, Nesbitt, SD. Overcoming racism and unconscious bias in ob/gyn. Contemporary OB/GYN.2020;64(8)15-17.

7. D’Alton ME, Friedman AM, Smiley RM, et al. National partnership for maternal safety: consensus bundle on venous thromboembolism. Obstet Gynecol. 2016;128(4):688-698.

8. a. Kilpatrick SJ, Berg C, Bernstein P, et al. Standardized severe maternal morbidity review: rationale and process. Obstet Gynecol. 2014;124(2 pt 1):361-366. b. Gardner R. Introduction to debriefing. Semin Perinatol. 2013;37(3):166-174.

9. a. Kilpatrick SJ, Menard K, Zahn CM, et al. Maternal Levels of Care. ACOG/SMFM Obstetric Care Consensus. Am J Obstet Gynecol. 2019;134:e41-55. b. Building US capacity to review and prevent maternal deaths. CDC Foundation. https://www.cdcfoundation.org/building-us-capacity-review-and-prevent-maternal-deaths

10. a. Emergencies in clinical obstetric (ECO). ACOG. https://www.acog.org/education-and-events/simulations/eco b. Deering S, Rowland J. Obstetric emergency simulation. Semin Perinatol. 2013;37(3):179-188.

11. Petersen EE, Davis NL, Goodman D, et al. Vital signs: pregnancy-related deaths, United States 2011-2015, and strategies for prevention,13 states, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019;68(18):423-429.

12. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891