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Standardized Severe Maternal Morbidity Review: Rationale and Process

Kilpatrick, Sarah J., MD, PhD; Berg, Cynthia, MD, MPH; Bernstein, Peter, MD; Bingham, Debra, DrPH, RN; Delgado, Ana, CNM, MSN; Callaghan, William M., MD, MPH; Harris, Karen, MD, MPH; Lanni, Susan, MD; Mahoney, Jeanne, RN, BSN; Main, Elliot, MD; Nacht, Amy, CNM, MSN; Schellpfeffer, Michael, MD; Westover, Thomas, MD; Harper, Margaret, MD

doi: 10.1097/AOG.0000000000000397
Contents: Current Commentary

Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician–gynecologists, maternal–fetal medicine subspecialists, certified nurse–midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

A standardized multidisciplinary review process for cases of severe maternal morbidity is described.

Departments of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, Montefiore Medical Center, Bronx, New York, University of Florida College of Medicine, Gainesville, Florida, Virginia Commonwealth University, Richmond, Virginia, California Pacific Hospital, San Francisco, California, Medical College of Wisconsin, Milwaukee, Wisconsin, and Wake Forest University, Winston–Salem, North Carolina; the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; the Association of Women's Health, Obstetric and Neonatal Nurses and the American College of Obstetricians and Gynecologists, Washington, DC; the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; the University of Colorado College of Nursing, Aurora, Colorado; and the Cooper University Hospital, Cooper Medical School, Rowan University, Camden, New Jersey.

Corresponding author: Sarah J. Kilpatrick, MD, PhD, The Helping Hand of Los Angeles Endowed Chair and Chair of Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West Third St, Suite 160W, Los Angeles, CA 90048; e-mail:

The authors thank Anna Santa-Donato, MSN, RN, for her significant contribution to the severe maternal morbidity abstraction and assessment form.

Jeanne Mahoney RN, BSN, is an employee of the American College of Obstetricians and Gynecologists (the College). All opinions expressed in this article are the authors' and do not necessarily reflect the policies and views of the College. Any remuneration that the authors receive from the College is unrelated to the content of this article.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This article is being published concurrently in the July/August 2014 issue (Vol. 43, No.4) of Journal of Obstetric, Gynecologic, & Neonatal Nursing.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.