Maternal mortality and the role of the obstetric anesthesiologist

Maternal mortality is increasing in the United States and remains unacceptably high in many parts of the world. Pre-existing conditions and social determinants of health frequently contribute to maternal death. General solutions to enhance maternal safety focus on systems to identify women at high risk and to tailor the management before, during, and after pregnancy. This review highlights condition-specific solutions for the leading etiologies of maternal death, including cardiac disease, sepsis, hemorrhage, venous thromboembolism, hypertensive disorders of pregnancy, and amniotic fluid embolism. Although anesthesia is an exceedingly rare cause of maternal death, specific hazards remain, including airway management, high neuraxial block, and unintentional dural puncture. The review concludes with an overview of strategies to create an institutional culture of both safety and equity, including multidisciplinary team training, simulation, shared decision-making, family-centered care, and serious morbidity review.