Statewide Severe Maternal Morbidity Review in Illinois

Abstract

OBJECTIVE To address rising rates of severe maternal morbidity and persistent racial disparities, Illinois established severe maternal morbidity review in all obstetric hospitals. The purpose of this study is to describe the findings from the statewide severe maternal morbidity review in 2018. METHODS This is a retrospective analysis of a hospital-level severe maternal morbidity review that occurred in 2018 (n=408) compared with all 2018 Illinois live births (n=141,595), inclusive of any severe maternal morbidity cases resulting in a live birth before hospital discharge. Cases were chosen for review based on completeness of records, complexity of the case, or an assessment that cases presented opportunities for learning and quality improvement; ie, not all severe maternal morbidity cases were reviewed. We present descriptive characteristics that contributed to the severe maternal morbidity event, and health care professional, system, and patient opportunities to alter the severe maternal morbidity outcome. RESULTS A total of 408 severe maternal morbidity cases were reviewed. Women with severe maternal morbidity were more likely to be non-Hispanic Black, multiparous, aged 35 years or older, have public insurance, and receive inadequate prenatal care. The most common causes of severe maternal morbidity were hemorrhage (48%), and preeclampsia and eclampsia (20%). Overall, 42% of severe maternal morbidity cases had opportunities to improve care. Non-Hispanic Black women had a disproportionately high burden of severe maternal morbidity due to preeclampsia and eclampsia (31% vs 18.1%) and were more likely to need improvement in care compared with non-Hispanic White women (53% vs 39.0%). The most common opportunities to alter the severe maternal morbidity outcome were health care professional factors during the intrapartum (9%) and postpartum (10%) periods. CONCLUSION Standardized severe maternal morbidity review gives a fuller view of the state of maternal health and highlights opportunities to improve quality of care.

Findings From Severe Maternal Morbidity Surveillance and Review in Maryland

“…Obstetric hemorrhage was the main cause of SMM, followed by severe COVID-19 infection and HDP. Findings regarding non–COVID-19 primary causes of SMM are like those reported in the few prior studies 22 , 23 applying similar criteria for SMM identification. The high proportion of patients with COVID-19 infection is noteworthy; COVID-19 infection is associated with other pregnancy complications, such as HDP, postpartum hemorrhage, and other infections.…”

“…Obstetric hemorrhage was the main cause of SMM, followed by severe COVID-19 infection and HDP. Findings regarding non-COVID-19 primary causes of SMM are like those reported in the few prior studies 22,23 applying c Seizure disorder (n = 1) and stroke (n = 1).…”

“…Other facility-based SMM review projects have reported similar rates of preventability and an even higher contribution of clinician factors. 22 , 23 , 28 In tandem with previous studies reporting that clinician-level factors are associated with more severe SMM outcomes, 6 quality improvement initiatives should focus on clinician-level interventions for maximum impact. In addition, in our series, recommendations for care improvement were most often focused on the recognition and prevention and response domains within the 5Rs framework.…”

Trends and inequities in severe maternal morbidity in Massachusetts: A closer look at the last two decades

“…A population-based California study found Black non-Hispanics having 44% higher rates of SMM than non-Hispanic Whites, even after adjustment for demographic and medical risk factors [11]. A retrospective study in a single hospital in Illinois that reviewed selected SMM cases indicated that compared to non-Hispanic White, non-Hispanic Black birthing people were more likely to experience a disproportionately high burden of SMM due to preeclampsia and eclampsia (31% vs 18.1%) and were more likely to need improvement in care compared with non-Hispanic White birthing people (53% vs 39.0%) [13]. Black birthing people have not historically received optimal care and racism as a contributor to racial inequities in healthcare is now well recognized [9,[14][15][16][17].…”

“…While among Black birthing people SMM rates show a similar dose response with age, the rates were not significant for the 30-34 age group [aRR 1.10 (95% CI: 0.95-1.28)].While education level was not significantly related to SMM20 for Blacks, high school or less was significantly associated with higher SMM rates among Whites [aRR 1.23 (95% CI: 1.13, 1.34)]. SMM rates for those on public insurance were significantly higher with comparable risks for White [aRR 1.23 (95% CI: 1 13,. 1.33)] and Black [aRR 1.25 (95% CI: 1.09, 1.44)] birthing people.…”