Standardized severe maternal morbidity review: rationale and process.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Quality Improvement

Background:

• Rising rates of severe maternal morbidity and mortality in the United States necessitate targeted interventions.
• A national call exists to identify and review cases of severe maternal morbidity, including intensive care unit admissions or significant blood transfusions.
• Existing guidance for reviewing these critical cases is lacking, hindering systematic improvement efforts.

Purpose of the Study:

• To present guidelines for a standardized, interdisciplinary severe maternal morbidity review process.
• To identify actionable systems, professional, and facility factors contributing to severe maternal morbidity.
• To enhance institutional obstetric safety and reduce maternal morbidity and mortality.

Main Methods:

• Development of guidelines by a multidisciplinary working group including obstetrician-gynecologists, maternal-fetal medicine specialists, nurse-midwives, and registered nurses.
• Presentation of a comprehensive review process covering committee organization, medical record abstraction and assessment, review culture, data management, timing, and confidentiality.
• Reference to a sample severe maternal morbidity abstraction and assessment form for practical application.

Main Results:

• A structured framework for conducting severe maternal morbidity reviews is proposed.
• The guidelines aim to facilitate the identification of systemic and facility-level factors impacting maternal outcomes.
• The process is designed to be adaptable across different healthcare settings.

Conclusions:

• Implementing a standardized interdisciplinary review process is crucial for addressing severe maternal morbidity.
• Such reviews can lead to targeted improvements in obstetric care, enhancing patient safety.
• The proposed guidelines offer a roadmap for institutions to systematically reduce severe maternal morbidity and mortality.