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Research Letter| Volume 5, ISSUE 4, 100888, April 2023

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Evaluating a pilot, facility-based severe maternal morbidity surveillance and review program in Maryland—an American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine Rx at work

Published:February 08, 2023DOI:https://doi.org/10.1016/j.ajogmf.2023.100888
Evaluating a pilot, facility-based severe maternal morbidity surveillance and review program in Maryland—an American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine Rx at work
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      Severe maternal morbidity (SMM) includes potentially life-threatening pregnancy complications and can have long-term health consequences for women.

      American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016;215:B17–22.

      In the United States, SMM events are most frequently identified through an algorithm of the International Classification of Diseases, 10th Revision (ICD-10) codes developed by the Centers for Disease Control and Prevention (CDC) using administrative hospital discharge data.
      • Callaghan WM
      • Creanga AA
      • Kuklina EV.
      Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.
      Obstet Gynecol. 2012; 120: 1029-1036
      ,
      • Reid LD
      • Creanga AA.
      Severe maternal morbidity and related hospital quality measures in Maryland.
      J Perinatol. 2018; 38: 997-1008
      Although important for deriving population-level SMM trends, these data are primarily collected for billing and are prone to coding errors.

      American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016;215:B17–22.

      , 
      • Callaghan WM
      • Creanga AA
      • Kuklina EV.
      Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.
      Obstet Gynecol. 2012; 120: 1029-1036
      , 
      • Reid LD
      • Creanga AA.
      Severe maternal morbidity and related hospital quality measures in Maryland.
      J Perinatol. 2018; 38: 997-1008
      The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommend that, in addition to reviewing maternal deaths, birthing facilities should routinely identify and review SMM events to characterize circumstances that led to SMM and to determine if the outcome was preventable.

      American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016;215:B17–22.

      Subsequently, facilities can implement practice changes and quality improvement (QI) initiatives to prevent future adverse outcomes. In July 2020, the Maryland Maternal Health Innovation Program (MDMOM) piloted facility-based SMM surveillance and review in 6 of 32 birthing hospitals in Maryland, representing approximately 25% of births in the state, using specific ACOG/SMFM guidance.
      • Wolfson C
      • Qian J
      • Chin P
      • et al.
      Findings from severe maternal morbidity surveillance and review in Maryland.
      JAMA Netw Open. 2022; 5e2244077
      We evaluated the key attributes and usefulness of this program to inform its scale-up.
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      References

      1. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016;215:B17–22.

        View in Article
        • Callaghan WM
        • Creanga AA
        • Kuklina EV.
        Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.
        Obstet Gynecol. 2012; 120: 1029-1036
        View in Article
        • Reid LD
        • Creanga AA.
        Severe maternal morbidity and related hospital quality measures in Maryland.
        J Perinatol. 2018; 38: 997-1008
        View in Article
        • Wolfson C
        • Qian J
        • Chin P
        • et al.
        Findings from severe maternal morbidity surveillance and review in Maryland.
        JAMA Netw Open. 2022; 5e2244077
        View in Article

      5. Centers for Disease Control and Prevention. Updated Guidelines for Evaluating Public Health Surveillance Systems: recommendations from the guidelines working group. 2001. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm. Accessed March 21, 2022.

        View in Article

      Article info

      Publication history

      Published online: February 08, 2023
      Accepted: January 31, 2023
      Received in revised form: January 24, 2023
      Received: November 15, 2022

      Footnotes

      The authors report no conflict of interest.

      This study received funding from the Health Resources and Services Administration (HRSA) under award number U7AMC337170100. The content is solely the responsibility of the authors and does not necessarily represent the official views of the HRSA.

      Identification

      DOI: https://doi.org/10.1016/j.ajogmf.2023.100888

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      © 2023 Elsevier Inc. All rights reserved.

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