National Initiative Aimed at Reducing Maternal Deaths Shows Early Signs of Improvement in Severe Maternal Morbidity

January 2, 2018

Washington, D.C.—Four states that were the first to join a national initiative aimed at reducing U.S. maternal mortality and morbidity have made promising improvements in maternal morbidity rates evident in the first round of outcomes data released by the American College of Obstetricians and Gynecologists (ACOG) today.

The Alliance for Innovation in Maternal Health (AIM) is a national data-driven maternal safety and quality improvement initiative that relies on a partnership between state health departments, health associations and perinatal collaboratives and hospitals, to implement and report progress on consistent maternity care practices, or “bundles,” for common pregnancy-related conditions.

According to the data submitted by the four states that were implementing the hemorrhage and hypertension bundles in 2015, there has been a decrease in the maternal morbidity rate, ranging from 8.3 to 22.1 percent, bringing the average overall rate of severe maternal morbidity to under 2 percent.

“For every maternal death, we know there are about 100 episodes of severe maternal morbidity,” said ACOG Vice President of Health Policy Barbara Levy, M.D. Chronic conditions such as high blood pressure, heart disease, obesity and diabetes are some of the leading causes of poor outcomes for women during childbirth. So, we want to herald these improvements in severe morbidity because they directly impact maternal deaths.”

The four states submitted baseline data for the three years prior to joining the initiative. Each state’s baseline data indicated a severe maternal morbidity rate between 1.9 to 2.1 percent. Data from participating hospitals in those same states for the second to fourth quarter of 2016, collectively representing 266,717 births, indicated a reduction in the severe maternal morbidity rate to 1.5 to 1.9 percent—an overall 20 percent decrease.

“Currently, there are 23 states as part of the AIM initiative, and they are all at different stages of the process,” said Levy. “So, as they align with their state coordinating body and begin implementing the safety bundles and recording information for process measures, more data will be forthcoming. It’s important to recognize that it takes time to make a significant culture shift.”

Process and structure measures are different for each safety bundle. For the hemorrhage bundle—the leading cause of preventable maternal mortality—it includes hospitals having an action protocol, an accessible hemorrhage cart containing the necessary equipment, staff education and drills.

“The data are suggesting that the hospitals with a hemorrhage protocol and/or four or more hemorrhage structure and process measures in place also showed the greatest reduction in severe maternal morbidity from hemorrhage,” Levy said. “We are seeing significant adoption of these bundle measures at hospitals across the country and it’s reassuring. Ultimately, it means that lives will be saved.”

The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. 


American College of Obstetricians and Gynecologists
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