Implementing Statewide Severe Maternal Morbidity Review: The Illinois Experience

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Quality Improvement

Background:

• Severe maternal morbidity (SMM) rates have significantly increased in the US.
• Factors like advanced maternal age and chronic conditions do not fully explain the rise in SMM.
• National health organizations recommend facility-level reviews to address preventable SMM.

Purpose of the Study:

• To evaluate the feasibility and impact of statewide, facility-level multidisciplinary reviews for severe maternal morbidity.
• To identify factors contributing to preventable SMM and develop actionable recommendations for quality improvement.
• To assess the effectiveness of SMM reviews in addressing rising rates of maternal morbidity and mortality.

Main Methods:

• Statewide surveillance identified SMM cases based on intensive care unit admission or significant blood transfusion.
• A multidisciplinary committee reviewed selected SMM cases for preventability.
• Reviews identified contributing factors and formulated recommendations for quality improvement.

Main Results:

• Over 1100 SMM cases were identified in Illinois from July 2016 to June 2017, a rate of 76 per 10,000 pregnancies.
• Hemorrhage was the leading cause of SMM, accounting for over 50% of cases.
• Most SMM cases occurred during delivery hospitalization, with over half involving cesarean sections.

Conclusions:

• Facility-level SMM review is a feasible and acceptable approach for statewide implementation.
• Multidisciplinary reviews are essential for identifying SMM factors and developing interventions.
• Maternal mortality reviews alone are insufficient; in-depth SMM reviews are needed to prevent severe maternal outcomes.