Next Steps to Reduce Maternal Morbidity and Mortality in the USA

Authors and Disclosures

Sarah J Kilpatrick

Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, 8635 W 3rd Street, Suite 160-W, Los Angeles, CA 90048, USA Tel.: +1 310 423 7433 Fax: +1 310 423 3470 kilpatricks@cshs.org

Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.

Sidebar

Executive Summary

The problem

• Maternal mortality in the USA has increased since the 1990s.

• Large proportion of these deaths are likely preventable.

Approach to prevention of maternal mortality: severe maternal morbidity

• Maternal death likely has followed a progression from severe maternal morbidity.

• Severe morbidity is far more common than maternal mortality.

• Excellent markers of severe morbidity are transfusion of four or more units of blood and or intensive care unit admission in peripartum women.

• Identifying and reviewing all severe morbidities is likely to yield data to direct interventions to reduce morbidity and mortality.

Characterizing preventable maternal morbidity and mortality

• Morbidity review should focus on provider, system and patient factors to determine if outcome could be improved if some aspect of care had been different.

Specific steps to reduce maternal mortality and morbidity

• Six specific recommendations are made to reduce morbidity and mortality including gaining multidisciplinary agreement to reduce mortality, creating national bundles to address specific obstetric problems associated with morbidity and death, and reviewing all maternal severe morbidities and mortalities.

Future perspective

• Investigation focused on the impact of maternal age, ethnicity and race, obesity, and cesarean delivery rate on maternal morbidity and death is called for.

• Reducing US maternal mortality and morbidity will take the commitment of all providers of obstetric care, the healthcare institutions, public health institutions and the public to be successful.