Lessons of severe maternal morbidity
Sarah J Kilpatrick, MD, PhD
Cynthia J Berg, MD, MPH
Neither author reports a conflict of interest in respect to the content of this article.
A better understanding of the care and outcomes of women with severe morbidity who survive should provide insight into ways to improve care for all women and reduce both severe morbidity and mortality.
Fortunately, the number of maternal deaths in the United States is relatively low.1 Every one of the approximately 700 maternal deaths each year, however, has a tragic and permanent impact on the woman’s family and on her caregivers. For a couple of the most common causes of maternal death, hemorrhage and hypertensive disorders, national efforts have led to the creation of guidelines and checklists to help recognize and manage them.2-4 Nevertheless, although the proportion of maternal deaths from these conditions has decreased, the total number of maternal deaths continues to increase, from 7.2 per 100,000 live births in 1987 to 17.8 per 100,000 live births in 2011.5-7 Given our healthcare resources, this trend is shocking and unacceptable.
In developed countries, 30% to 50% of maternal deaths are preventable, particularly those related to hemorrhage and hypertensive disorders of pregnancy.8,9 This high rate of preventability strongly suggests that we should be able to reduce deaths if we better understand why women die. But, as noted previously, we do not have enough maternal deaths in the United States to really study them. Women whom ultimately die, however, rarely transition directly from a healthy state to death but rather progress along a continuum from health through severe morbidity to death.10 Further, severe maternal morbidity (SMM) occurs almost 100 times more frequently than maternal death, affecting more than 60,000 women per year or 1.5% of all deliveries, and has also been increasing.11-13 Finally, it is clear that women with SMM or near-miss morbidity have similar diagnoses and similar rates of preventable factors as do women who die.10
A better understanding of the care and outcomes of women with severe morbidity who survive should provide insight into ways to improve care for all women and reduce both severe morbidity and mortality. Therefore, routine evaluation of care and outcomes of women with SMM should result in information that could lead to improved care and reduced rates of preventable morbidity and death.