Maternal Mortality in Pregnancy

Lindsey Carr

Associate Editor for Contemporary OB/GYN

A presentation at the American College of Obstetrics and Gynecology’s (ACOG) Annual Clinical and Scientific Meeting, which started on April 30, discussed maternal mortality in pregnancy and how physicians can reduce rates.

To register and for more information, check out www.acog.org.

Follow www.contemporaryobgyn.net for coverage during the conference, which was held from April 30 through May 2.

“We have among the highest maternal mortality rate of any industrialized nation,” said Susan Mann, MD, at this year’s meeting.

On July 1, 2020, the Joint Commission released standards to improve the quality and safety of care during pregnancy and postpartum. They also determined the highest impact areas including early recognition and timely treatment of postpartum hemorrhage and severe hypertension. There is no uniform approach for all hospitals regarding implementation of the recommendations.

On Sunday, May 2, Susan Mann, MD, and Kimberlee McKay, MD, led a presentation on what hospitals can and should do to prevent maternal mortality. Mann is an ob/gyn specialist, assistant professor and a fellow of ACOG based in Brookline, Massachusetts. McKay is an ob/gyn in Sioux Falls, South Dakota. In 2015, she became the vice president of the Avera OB/GYN Service Line, which serves 14 hospitals over 72,000 miles throughout eastern South Dakota, Minnesota, Iowa, and Nebraska. Avera uses the Maternal Level of Care (MLoC) framework to create MLoC-specific bundles and care pathways that work within the confines of local hospital resources.

Mann spoke first during the presentation, explaining that Non-Hispanic Black women experienced the highest rate of pregnancy-related mortality by race/ethnicity based upon data from 2014 to 2017. She explained the new Joint Commission Standards and their expectations, highlighting the most important issues. “Hospitals are going to be expected to execute timely treatment of maternal hemorrhage and severe hypertension/preeclampsia,” Mann explained.

To reduce the likelihood of harm related to maternal severe hypertension and preeclampsia, hospitals should provide role-specific education to all staff and providers who treat pregnant and postpartum patients about the hospital’s evidence-based severe hypertension and preeclampsia procedures. At minimum, education should occur at orientation, when changes to the procedure occur, or every 2 years. They should also conduct drills at least annually to determine system issues as part of ongoing quality improvement efforts, Mann noted.

Team training in rural hospitals must be adapted but should include a discussion of all patients in-house and ED volume. “Rural hospitals are very limited by blood bank,” McKay said. “You have to look at your hospital and say, ‘Is this the right hospital for the patient?’ and make the decision from there.”

To reduce disparities in pregnancy-related mortality, the speakers concluded, hospitals and health care systems can:

  1. Implement standardized protocols in quality improvement initiatives, especially among facilities that serve disproportionately affected communities.
  2. Identify and address implicit bias in health care that would likely improve patient-provider interactions, health communication, and health outcomes.

ACOG’s conference proceedings concluded on Sunday, May 2. For information on how to access recorded sessions, visit www.acog.org.