Implementing Statewide Severe Maternal Morbidity Review: The Illinois Experience

Koch, Abby; Roesch, Pamela; Garland, Caitlin E.; Geller, Stacie E.

doi:10.1097/phh.0000000000000752

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…Our broader results are consistent with other evidence [ 11 ] linking maternal morbidity and reproductive outcomes [ 59 ], thus highlighting the crucial importance of primary prevention and reducing the burden of SMM to mitigating the burden of SNM [ 2 , 60 ] and its associated consequences [ 10 , 12 ]. It is an imperative that transcends the socioeconomic status of a country.…”

Section: Discussionsupporting

confidence: 91%

“…Some HICs [ 62 , 63 ] have maternity outcome surveillance systems which use regular data updates to identify trends and adverse outcomes associated with SMM. However, although there is acknowledgement of rising rates of SMM [ 60 ] and the limitations of current surveillance systems [ 64 ], only a few HICs have instituted specific monitoring systems for SMM [ 62 , 63 ]. Developing a universally accepted classification system for SMM [ 61 , 65 , 66 , 67 , 68 , 69 ] would help in the standardized collection and reporting of important clinical data.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

Mengistu

Turner

Flatley

et al. 2020

JCM

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While there is clear evidence that severe maternal morbidity (SMM) contributes significantly to poor maternal health outcomes, limited data exist on its impact on perinatal outcomes. We undertook a systematic review and meta-analysis to ascertain the association between SMM and adverse perinatal outcomes in high-income countries (HICs). We searched for full-text publications in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus databases. Studies that reported data on the association of SMM and adverse perinatal outcomes, either as a composite or individual outcome, were included. Two authors independently assessed study eligibility, extracted data, and performed quality assessment using the Newcastle–Ottawa Scale. We used random-effects modelling to calculate odds ratios (ORs) with 95% confidence intervals. We also assessed the risk of publication bias and statistical heterogeneity using funnel plots and Higgins I2, respectively. We defined sub-groups of SMM as hemorrhagic disorders, hypertensive disorders, cardiovascular disorders, hepatic disorders, renal disorders, and thromboembolic disorders. Adverse perinatal outcome was defined as preterm birth (before 37 weeks gestation), small for gestational age (SGA) (birth weight (BW) < 10th centile for gestation), low birthweight (LBW) (BW < 2.5 kg), Apgar score < 7 at 5 min, neonatal intensive care unit (NICU) admission, stillbirth and perinatal death (stillbirth and neonatal deaths up to 28 days). A total of 35 studies consisting of 38,909,426 women were included in the final analysis. SMMs associated with obstetric hemorrhage (OR 3.42, 95% CI: 2.55–4.58), severe hypertensive disorders (OR 6.79, 95% CI: 6.06–7.60), hepatic (OR 3.19, 95% CI: 2.46–4.13) and thromboembolic disorders (OR 2.40, 95% CI: 1.67–3.46) were significantly associated with preterm birth. SMMs from hypertensive disorders (OR 2.86, 95% CI: 2.51–3.25) or thromboembolic disorders (OR 1.48, 95% CI: 1.09–1.99) were associated with greater odds of having SGA infant. Women with severe hemorrhage had increased odds of LBW infant (OR 2.31, 95% CI: 1.57–3.40). SMMs from obstetric hemorrhage (OR 4.16, 95% CI: 2.54–6.81) or hypertensive disorders (OR 4.61, 95% CI: 1.17–18.20) were associated with an increased odds of low 5-min Apgar score and NICU admission (Severe obstetric hemorrhage: OR 3.34, 95% CI: 2.26–4.94 and hypertensive disorders: OR 3.63, 95% CI: 2.63–5.02, respectively). Overall, women with SMM were 4 times more likely to experience stillbirth (OR 3.98, 95% CI: 3.12–7.60) compared to those without SMM with cardiovascular disease (OR 15.2, 95% CI: 1.29–180.60) and thromboembolic disorders (OR 9.43, 95% CI: 4.38–20.29) conferring greatest risk of this complication. The odds of neonatal death were significantly higher in women with SMM (OR 3.98, 95% CI: 2.44–6.47), with those experiencing hemorrhagic (OR 7.33, 95% CI: 3.06–17.53) and hypertensive complications (OR 3.0, 95% CI: 1.78–5.07) at highest risk. Overall, SMM was also associated with higher odds of perinatal death (OR 4.74, 95% CI: 2.47–9.12) mainly driven by the increased risk in women experiencing severe obstetric hemorrhage (OR 6.18, 95% CI: 2.55–14.96). Our results highlight the importance of mitigating the impact of SMM not only to improve maternal health but also to ameliorate its consequences on perinatal outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

Mengistu

Turner

Flatley

et al. 2020

JCM

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“…In 2016, Illinois integrated SMM review into the existing regionalized perinatal system of care in all birthing hospitals in the state. Detailed information about the SMM review process in Illinois has been published previously 6,7. In brief, based on recommendations by the CDC and the ACOG, Illinois implemented a modified 2-factor system to identify SMM for in-depth case review: any intensive care unit (ICU) or critical care unit admission, transfusion of 4 or more units of packed red blood cells, or both, from conception to 42 days postpartum 6,8.…”

Section: Methodsmentioning

confidence: 99%

Comparing State-Level and Facility-Based Review to Assess Quality of Severe Maternal Morbidity Reviews

Garland

Craemer

Koch

et al. 2023

Journal of Public Health Management and Practice

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Objective: To compare results from facility-level and state-level severe maternal morbidity (SMM) reviews in Illinois. Design: We report descriptive characteristics about SMM cases and compare the results of both review processes, including the primary cause, assessment of preventability, and factors that contributed to the severity of the SMM cases. Setting: All birthing hospitals in Illinois. Participants: A total of 81 SMM cases were reviewed by a facility-level committee and the state-level review committee. SMM was defined as any intensive care or critical care unit admission and/or transfusion of 4 or more units of packed red blood cells from conception to 42 days postpartum. Results: Among the cases reviewed by both committees, hemorrhage was the primary cause of morbidity, with 26 (32.1%) and 38 (46.9%) hemorrhage cases identified by the facility-level and state-level committees, respectively. Both committees identified infection/sepsis (n = 12) and preeclampsia/eclampsia (n = 12) as the next most common causes of SMM. Statelevel review found more cases potentially preventable (n = 29, 35.8% vs n = 18, 22.2%) and more cases not preventable but improvement in care needed (n = 31, 38.3% vs n = 27, 33.3%). State-level review found more provider and system opportunities to alter the SMM outcome and fewer patient opportunities than facility-level review. Conclusion: State-level review found more SMM cases potentially preventable and identified more opportunities to improve care than facility-level review. State-level review has the potential to strengthen facility-level reviews by identifying opportunities to improve the review process and develop recommendations and tools to aid facility-level reviews.

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“…Immediate postpartum hemorrhage (PPH) remains a major cause of maternal deaths worldwide [ 1 , 2 ]. Obstetric hemorrhage is also the principal cause of severe maternal morbidity [ 3 ], which includes psychological and emotional distress. The incidence rates of mild (≥500 mL and <1000 mL) and severe (≥1000 mL) PPH are reported to be around 6.0% and 1.86% of all deliveries [ 4 ], respectively, although they vary widely throughout the world [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

et al. 2022

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Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures.

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Implementing Statewide Severe Maternal Morbidity Review: The Illinois Experience

Cited by 10 publications

References 11 publications

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

Comparing State-Level and Facility-Based Review to Assess Quality of Severe Maternal Morbidity Reviews

Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

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