Revival of a Core Public Health Function: State- and Urban-Based Maternal Death Review Processes

Abstract

This article reviews some of the current challenges for maternal death review in the United States, describes key findings from an assessment of U.S. capacity for conducting maternal death reviews, and introduces a new Maternal Mortality Initiative that aims to develop standardized guidelines for state- or city-based maternal deaths review processes.

Pregnancy-Related Mortality in California

“…These reviews are valuable even in states with low numbers of maternal deaths to identify locally important improvement opportunities and develop ongoing surveillance. 5 Our findings illustrate the need for public health interventions aimed at helping all women understand and recognize their risks and attain optimal prepregnancy health and weight. These findings also underscore the need for focused approaches to improve care such as hospital-based safety bundles for hemorrhage, preeclampsia, and venous thromboembolism prevention as well as comprehensive programs for patient education, communication, and teamwork development.…”

“…2,3 This rise has prompted a renewed focus at national and state levels to examine the causes and contributing factors of maternal death and improve public health and clinical practice. 4,5 Most previous studies of pregnancy-related deaths have included demographic and limited clinical information but did not compare specific causes of death for factors other than preventability. 3,[6][7][8] Studies focused on a single cause of pregnancyrelated mortality often were based on administrative data sets with limited access to clinical records and unable to identify improvement opportunities.…”

Pregnancy-Related Mortality in the United States, 2006–2010

“…21,22 Research has shown that when protocols and clinical policies are implemented systematically, adverse maternal outcomes are reduced significantly. 25 State-based review of all pregnancy-related deaths and expansion into review of severe maternal morbidity could help improve the quality of maternity care for U.S. women. Pregnancy-related deaths may be undercounted.…”

Trends in Maternal Mortality by Sociodemographic Characteristics and Cause of Death in 27 States and the District of Columbia

“…Further identifying and excluding incidental causes of death, as well as changes to coding to decrease the near-exclusive reliance on the checkbox to identify maternal deaths might improve data quality. Finally, the recent growth in state maternal mortality review committees can improve data quality (27), but only if information from maternal mortality reviews is used to update vital statistics information on the cause and circumstances of death.…”