What are the recommendations to reduce maternal mortality?

Recommendations to Reduce Maternal Mortality

The most effective approach to reducing maternal mortality requires implementing comprehensive maternal safety bundles, addressing racial disparities, improving access to care, and ensuring standardized emergency protocols across all healthcare settings. 1

Preconception and Prenatal Care

• Identify and treat pre-existing conditions before conception
• Provide appropriate contraception and subspecialty collaboration for women with chronic medical conditions
• Assess socioenvironmental and behavioral risks for timely intervention
• Conduct initial risk assessment at first prenatal visit with continuous reassessment throughout pregnancy 1

Risk Factors Requiring Special Attention

• Advanced maternal age (women ≥35 years have higher pregnancy-related mortality) 2
• Pre-pregnancy obesity and chronic medical conditions 2
• Substance use disorders (opioid use disorder increases maternal death odds by 4x) 2
• Race/ethnicity (non-Hispanic Black and American Indian/Alaska Native women have 3.2x and 2.3x higher mortality rates than non-Hispanic White women) 2

Standardized Emergency Care Protocols

• 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 deterioration 2
• Develop standardized protocols for common obstetric emergencies:
  • Hemorrhage management with proper oxytocin administration (10-40 units in 1,000 mL non-hydrating solution for postpartum bleeding) 3
  • Severe hypertension management
  • Venous thromboembolism prevention 1

Avoiding Pitfalls in Emergency Care

• Monitor patients receiving IV oxytocin continuously by trained personnel 3
• Discontinue oxytocin immediately in cases of uterine hyperactivity or fetal distress 3
• Be aware of oxytocin's antidiuretic effect which can lead to water intoxication 3
• Avoid oxytocin with cyclopropane anesthesia due to potential cardiovascular effects 3

Postpartum Care

• Shift from a single postpartum visit to a comprehensive set of visits customized to women's needs 2, 1
• Extend care beyond the traditional 6-week postpartum period 1
• Implement postpartum telehealth monitoring with home blood pressure monitors for high-risk women 1
• Monitor for complications in the postpartum period, when more than half of all pregnancy-related deaths occur 2

Addressing Disparities and Improving Healthcare Systems

• 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
  • Group prenatal care models
  • Remote monitoring technologies for rural and medically underserved areas 2, 1

Regionalized Maternal Care

• Establish a complete and integrated system of perinatal regionalization with risk-appropriate maternal care levels (I-IV) 4
• Implement appropriate transfer protocols for high-risk cases 1
• Address rural healthcare disparities (rural residents have 9% higher probability of severe maternal morbidity) 2
• Coordinate care between multiple institutions within a region 4

Quality Improvement and Surveillance

• Establish maternal mortality review committees (MMRCs) to analyze deaths and inform prevention strategies 2, 1
• Utilize the Maternal Mortality Review Information Application (MMRIA) data system for standardized review 2
• Implement the ERASE MM Program to identify and review maternal deaths 2
• Conduct standardized severe maternal morbidity reviews to identify systems, professional, and facility factors that can be improved 5

Healthcare Workforce Training

• Expand provider training in obstetric emergencies 1
• Improve communication within care teams 1
• Train providers to recognize early warning signs of the leading causes of maternal mortality:
  • Cardiovascular conditions
  • Noncardiovascular medical conditions
  • Infection 2, 6

Federal and State Initiatives

• Support the State Maternal Health Innovation Program to address maternal health disparities 2
• Utilize the Supporting Maternal Health Innovation Program for technical assistance 2
• Implement the Rural Maternity and Obstetrics Management Strategies program to improve access in rural communities 2
• Support the Healthy Start Initiative to reduce racial/ethnic differences in maternal outcomes 2

By implementing these evidence-based recommendations, healthcare systems can significantly reduce maternal mortality rates and improve maternal health outcomes, particularly among vulnerable populations who face the highest risks.