Maternal Mortality in the US

Are there better ways to improve it?

In this comprehensive analysis in AJOG of 42 state and city maternal mortality review committees found that between 53-94% of pregnancy-associated deaths and 45-100% of pregnancy-related deaths in the US are preventable, with wide variation across states despite using similar review processes. Deaths from preeclampsia-eclampsia and mental health conditions were deemed >90% preventable, while hemorrhage and cardiovascular deaths were >80% preventable. Patient-family factors and provider factors were most commonly identified as contributing to preventable deaths, with discrimination or racism noted as contributors in 37.7% of pregnancy-related deaths. The study calls for standardizing maternal mortality review processes to better inform evidence-based interventions and policy changes.

Obstetric Intelligence Commentary: While these findings highlight the tragic reality that most maternal deaths could be prevented, the enormous variation between states—from 45% to 100% preventability—reveals a critical flaw in our current review system. This variation likely reflects differences in reviewer expertise, data availability, and subjective judgment rather than actual differences in preventability. We need standardized, evidence-based criteria for assessing preventability that focus less on broad percentages and more on identifying specific, actionable interventions at the clinical, system, and policy levels. However, the elephant in the room remains our fragmented healthcare system—European countries with universal healthcare have over 60% lower maternal mortality rates than the US, suggesting that systemic healthcare access and continuity of care are fundamental prerequisites for truly preventable maternal death reduction.

https://www.ajog.org/article/S0002-9378(24)00870-6/fulltext