Key takeaways:
- MMRC recommendations address contributing factors across patient, community, clinician, and system levels simultaneously, reflecting the multifactorial nature of infection-related maternal mortality.
- Robust evidence on which specific interventions reduce maternal mortality—and particularly racial and ethnic disparities in mortality—remains limited, in part because maternal deaths are relatively rare events.
- The AIM Sepsis in Obstetric Care Patient Safety Bundleoffers a multilevel framework endorsed by ACOG and SMFM, emphasizing institution-specific diagnostic criteria, system readiness, and structured learning from adverse outcomes.
Reducing pregnancy-related deaths from infection will require coordinated interventions across patient, clinician, and system levels—not a single protocol or training initiative—according to Naima T. Joseph, MD, MPH, whose analysis of Maternal Mortality Review Committee (MMRC) data from 29 states has been reported in two prior installments.1
Having previously addressed the clinical and demographic patterns of infection-related maternal deaths and the role of cross-disciplinary recognition and postpartum access, Joseph turned in this conversation to the structure of MMRC recommendations and the evidence base—and limitations—behind them.
MMRCs identified more than 400 distinct contributing factor classes across the cases reviewed. Joseph noted that delays and knowledge gaps were prominent themes, but emphasized that the recommendations generated do not map neatly onto a single level of the health care system.
"MMRCs recommended across the patient and community level interventions across education and when to seek care, ways to reduce the patient burden on seeking care—for example, routine postpartum phone check-ins, ensuring that a high proportion of patients receive postpartum care, reducing insurance churn so that access to care is less of a barrier," she said. At the provider level, recommendations addressed awareness that recently pregnant patients may present to a wide variety of facilities, and the importance of equipping triage staff to recognize potential complications and escalate appropriately.
Joseph acknowledged the inherent challenge in measuring the effectiveness of these interventions. Maternal deaths, although deeply consequential, are relatively rare events—a reality that limits the availability of robust outcomes data and makes it especially difficult to identify which interventions produce meaningful reductions in mortality. Evidence on what works to reduce racial and ethnic disparities is even more limited.
"The data on effectiveness to reduce maternal mortality are quite limited," she said, "and there's even less empirical evidence regarding interventions that reduce racial and ethnic disparities."
Against that backdrop, she pointed to the AIM (Alliance for Innovation on Maternal Health) Sepsis in Obstetric Care Patient Safety Bundle as one of the most well-developed starting points currently available. The bundle, endorsed by ACOG and the Society for Maternal-Fetal Medicine, addresses infection-related mortality across multiple levels simultaneously—calling for standardized diagnostic criteria developed using institution-specific data, system readiness to escalate care wherever a patient presents, and mechanisms for tracking, reporting, and learning from failures to rescue.
"Think less about one intervention as improving standardized diagnostic criteria, but a package of interventions that starts from improving readiness and recognition, but also using your own hospital and population-level data to improve health and ultimately prevent these complications in your patients," Joseph said.
The framing reflects a broader principle Joseph returned to throughout the series: that maternal mortality results from a complex, interlocking web of quality-of-care failures, structural racism, socioeconomic factors, and community-level resource gaps—and that solutions siloed at any one level are unlikely to be sufficient.
REFERENCE
1. Joseph NT, Trost SL, Hollier LM, et al. Pregnancy-related mortality due to infection: maternal mortality review committees in 29 U.S. States, 2017-2019. Obstet Gynecol. 2026 Jan 9. doi:10.1097/AOG.0000000000006172
