What are the key strategies to reduce maternal mortality?

Key Strategies to Reduce Maternal Mortality

The most effective strategies to reduce maternal mortality include implementing standardized approaches to emergency obstetric care, addressing racial disparities, ensuring continuous risk assessment throughout a woman's reproductive life course, and expanding insurance coverage before, during, and after pregnancy. 1

Comprehensive Risk Assessment and Management

Before Pregnancy

• Identify and treat pre-existing conditions before conception 1
• Provide appropriate contraception and subspecialty collaboration for women with chronic medical conditions 1
• Assess socioenvironmental and behavioral risks for timely intervention 1
• Ensure all women of childbearing age receive pregnancy-related health risk assessments 1

During Pregnancy

• Conduct initial risk assessment at first prenatal visit with continuous reassessment throughout pregnancy 1
• Implement early screening (by 10 weeks) to improve outcomes 2
• Screen universally for:
  • Depression, anxiety, intimate partner violence, substance use, and food insecurity 2
  • Gestational diabetes between 24-28 weeks 2
  • Asymptomatic bacteriuria and sexually transmitted infections 2

Postpartum Period

• Shift from a single postpartum visit to a comprehensive set of visits customized to women's needs 1
• Extend care beyond the traditional 6-week postpartum period to address medium and long-term complications 1
• Implement postpartum telehealth monitoring with home blood pressure monitors for high-risk women 1

Addressing Systemic and Racial Disparities

• Combat implicit bias and structural racism at provider and healthcare system levels 1
• Expand insurance coverage before, during, and after pregnancy 1
• Implement targeted interventions for vulnerable populations:
  • Peer education programs at historically Black colleges 1
  • Group prenatal care models for high-risk populations 1
  • Remote monitoring technologies for rural and medically underserved areas 1

Clinical Guidelines, Protocols, and Safety Bundles

• Implement maternal safety bundles through the Alliance for Innovation on Maternal Health (AIM) program 1
• Utilize maternal early warning criteria (MEWC) to identify women at risk for morbidity and mortality 1
• Develop and implement standardized protocols for obstetric emergencies such as:
  • Hemorrhage management (including appropriate oxytocin use) 3
  • Severe hypertension management 1
  • Venous thromboembolism prevention 1

Healthcare System Improvements

• Establish maternal mortality review committees (MMRCs) to analyze deaths and inform prevention strategies 1, 4
• Implement regionalized maternal care with appropriate transfer protocols for high-risk cases 1
• Decrease variation in care across facilities providing obstetric services 1
• Improve communication within care teams 1
• Expand provider training in obstetric emergencies 1

Cardiovascular Disease Prevention and Monitoring

• Implement universal cardiovascular disease screening for all pregnant and postpartum women 5
• Offer low-dose aspirin (81mg daily) starting at 12 weeks for women at risk of preeclampsia 2
• Treat chronic hypertension to maintain blood pressure below 140/90 mm Hg 2
• Recognize pregnancy complications as early warning signs for future cardiovascular disease risk 6

Common Pitfalls and Caveats

• Avoid focusing solely on acute obstetric emergencies while neglecting medium and long-term complications 1
• Don't underestimate the impact of social determinants of health on maternal outcomes 1
• Recognize that delays in recognition, diagnosis, or referral of high-risk women contribute significantly to preventable maternal mortality 1
• Be aware that women of color may experience lack of response to their expressed concerns due to implicit bias 1
• Remember that rural women face higher risks due to limited access to obstetric specialists 1

By implementing these evidence-based strategies comprehensively, healthcare systems can make significant progress in reducing maternal mortality and improving maternal health outcomes.