title: Standardized severe maternal morbidity review: rationale and process.
abstract: 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 four 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.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Kilpatrick
authors.forename: Cynthia
authors.initials: C
authors.lastname: Berg
authors.forename: Peter
authors.initials: P
authors.lastname: Bernstein
authors.forename: Debra
authors.initials: D
authors.lastname: Bingham
authors.forename: Ana
authors.initials: A
authors.lastname: Delgado
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
authors.forename: Karen
authors.initials: K
authors.lastname: Harris
authors.forename: Susan
authors.initials: S
authors.lastname: Lanni
authors.forename: Jeanne
authors.initials: J
authors.lastname: Mahoney
authors.forename: Elliot
authors.initials: E
authors.lastname: Main
authors.forename: Amy
authors.initials: A
authors.lastname: Nacht
authors.forename: Michael
authors.initials: M
authors.lastname: Schellpfeffer
authors.forename: Thomas
authors.initials: T
authors.lastname: Westover
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008428:Maternal Mortality; D009736:Nursing Process / Q000592:standards*; D009774:Obstetrics / Q000592:standards; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011366:Professional Review Organizations; D012015:Reference Standards; D017751:Safety Management / Q000379:methods / Q000458:organization & administration; D012720:Severity of Illness Index; D014481:United States; D016387:Women's Health