COMMENTARY

The Tragedy of Maternal Death and the Healthcare Provider's Role in Prevention

Emily E. Petersen, MD

Disclosures

October 22, 2018

Editorial Collaboration

Medscape &

Every year, about 700 women die in the United States as a result of pregnancy or pregnancy-related complications.[1] In the past year, many news reports have covered these devastating losses and the disparities that exist in maternal mortality. However, a recent report highlights one statistic that you may not have heard: About 60% of maternal deaths are preventable.

I'm Dr Emily Petersen, a medical officer in CDC's Division of Reproductive Health. As a practicing obstetrician/gynecologist, lead of CDC's Pregnancy Mortality Surveillance System, and a new mom, I believe that every maternal death is a tragedy. We can and must address maternal mortality. In this Medscape commentary, I will share some important findings from a new CDC report and highlight several resources that may be useful to healthcare providers as you work to prevent maternal deaths.

In early 2018, as part of the initiative "Building US Capacity to Review and Prevent Maternal Mortality," CDC and colleagues published a report from nine state-based maternal mortality review committees (MMRCs). These committees work to identify and review the deaths of women who die as a result of pregnancy, and then develop recommendations to prevent future deaths. The report noted that:

  • Nearly half of all pregnancy-related deaths were caused by hemorrhage, cardiovascular conditions, or infections;

  • Most pregnancy-related deaths were preventable;

  • Mental health conditions were a leading cause of death and also an important contributing factor for pregnancy-related deaths due to other causes; and

  • The leading causes of death varied by race. We also know that pregnancy-related mortality is three to four times higher among black women compared with white women[1]; understanding differences in the leading causes of death provides opportunities to reduce this gap.

Review committees identified an average of four contributing factors for each maternal death. While the committees found "patient and family factors"—such as knowledge of warning signs and the need to seek care—to be most common, they are often dependent on providers and systems of care. Provider factors, such as delays in diagnosis and effective treatments, and systems-of-care factors, like absence of policies and procedures and lack of coordinated patient management, were also common.

The committees identified several key recommendations as having the greatest potential for population-level reach. These included systems-of-care interventions such as ensuring access to risk-appropriate care for pregnant women and infants at high risk for complications. Other wide-reaching recommendations include:

  • Improving policies that promote prevention and treatment, such as screening procedures and substance use prevention or treatment programs;

  • Making use of evidence-based policies, procedures, and resources related to obstetric hemorrhage; and

  • Improving policies related to patient management.

CDC is working on a number of efforts to improve the likelihood that a woman will have a healthy pregnancy, delivery, and postpartum period, and to improve health outcomes for her baby as well. Some of our resources may be helpful to you. The CDC Levels of Care Assessment Tool (CDC LOCATe), is a Web-based resource that helps create standardized assessments of levels of maternal and neonatal care. The results from CDC LOCATe are a starting point for discussions about how states can improve health outcomes for women and infants.

CDC also supports perinatal quality collaboratives (PQCs), which are state networks of perinatal care providers working to improve the quality of care for mothers and babies. PQCs have contributed to important improvements in outcomes, including reductions in severe pregnancy complications. To learn more about these initiatives, please visit our website.

And through the Review to Action website, CDC and partners are working to empower the ongoing work of maternal mortality review committees to make and prioritize recommendations for action at the state and local level. Healthcare providers have a critical voice that needs to be heard on these review committees; to learn about review committees, including in your state, please visit the website.

Another resource that may be useful is the Alliance for Innovation on Maternal Health's Patient Safety Bundles, supported by the Health Resources and Services Administration. Built on established best practices in obstetric care, these bundles provide frameworks for care delivery on topics including obstetrical hemorrhage, severe hypertension/preeclampsia, and more.

Every maternal death leaves an irreplaceable hole in the fabric of our society. Because you are a trusted and respected authority on the health of your patients, you can bring about critical change to reduce maternal mortality in our country. Thank you.

Web Resources

Report From Nine MMRCs

CDC Levels of Care Assessment Tool (LOCATe)

Perinatal Quality Collaboratives

PQC Resource Guide

Review to Action

Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundles

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