Maternal mortality, near misses, and severe morbidity

Lowering rates through designated levels of maternity care

Gary Hankins, Steven L. Clark, Luis Pacheco, Dan O'Keeffe, Mary D'Alton, George Saade

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

An increase in the prevalence of obesity, hypertension, diabetes, and abnormal placentation, among others, has fueled the recent rise in maternal mortality, "near misses" and severe morbidity. In 1976, the March of Dimes published a report, "Toward Improving the Outcome of Pregnancy," which included recommendations for levels of perinatal care. Although the original intent was to address the needs of both mother and neonate, implementation in the ensuing years focused mostly on the latter. Currently, there are no well-defined nationally accepted levels of maternal care similar to those adopted by the American Academy of Pediatrics for neonatal intensive care units. When discussing regionalization of perinatal care, the needs of the mother are frequently overlooked. We propose that it is time to address this deficiency and develop levels of care that are specific to the mother. We expect that improving maternal care will also improve neonatal outcome. We call on various organizations and agencies to establish national standards and levels of maternity care much as our colleagues in neonatology have already successfully done. We canvassed the available publications by states and other countries and found a number of noteworthy examples. We propose that the goal would be an integrated maternal-fetal-neonatal care network, a model similar to what is done in stroke or emergency care. In addition to accepting transfers, the central facility functioning at the highest level would also be responsible for education, evidence-based best practices, policy development, and quality review and improvement within the network.

Original languageEnglish (US)
Pages (from-to)929-934
Number of pages6
JournalObstetrics and Gynecology
Volume120
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Maternal Mortality
Mothers
Morbidity
Perinatal Care
Neonatology
Placentation
Pediatric Intensive Care Units
Policy Making
Evidence-Based Practice
Neonatal Intensive Care Units
Emergency Medical Services
Pregnancy Outcome
Quality Improvement
Practice Guidelines
Publications
Obesity
Stroke
Organizations
Newborn Infant
Hypertension

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Maternal mortality, near misses, and severe morbidity : Lowering rates through designated levels of maternity care. / Hankins, Gary; Clark, Steven L.; Pacheco, Luis; O'Keeffe, Dan; D'Alton, Mary; Saade, George.

In: Obstetrics and Gynecology, Vol. 120, No. 4, 10.2012, p. 929-934.

Research output: Contribution to journalArticle

@article{7c23dac9bf93499a97f3dd27178b33d6,
title = "Maternal mortality, near misses, and severe morbidity: Lowering rates through designated levels of maternity care",
abstract = "An increase in the prevalence of obesity, hypertension, diabetes, and abnormal placentation, among others, has fueled the recent rise in maternal mortality, {"}near misses{"} and severe morbidity. In 1976, the March of Dimes published a report, {"}Toward Improving the Outcome of Pregnancy,{"} which included recommendations for levels of perinatal care. Although the original intent was to address the needs of both mother and neonate, implementation in the ensuing years focused mostly on the latter. Currently, there are no well-defined nationally accepted levels of maternal care similar to those adopted by the American Academy of Pediatrics for neonatal intensive care units. When discussing regionalization of perinatal care, the needs of the mother are frequently overlooked. We propose that it is time to address this deficiency and develop levels of care that are specific to the mother. We expect that improving maternal care will also improve neonatal outcome. We call on various organizations and agencies to establish national standards and levels of maternity care much as our colleagues in neonatology have already successfully done. We canvassed the available publications by states and other countries and found a number of noteworthy examples. We propose that the goal would be an integrated maternal-fetal-neonatal care network, a model similar to what is done in stroke or emergency care. In addition to accepting transfers, the central facility functioning at the highest level would also be responsible for education, evidence-based best practices, policy development, and quality review and improvement within the network.",
author = "Gary Hankins and Clark, {Steven L.} and Luis Pacheco and Dan O'Keeffe and Mary D'Alton and George Saade",
year = "2012",
month = "10",
doi = "10.1097/AOG.0b013e31826af878",
language = "English (US)",
volume = "120",
pages = "929--934",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Maternal mortality, near misses, and severe morbidity

T2 - Lowering rates through designated levels of maternity care

AU - Hankins, Gary

AU - Clark, Steven L.

AU - Pacheco, Luis

AU - O'Keeffe, Dan

AU - D'Alton, Mary

AU - Saade, George

PY - 2012/10

Y1 - 2012/10

N2 - An increase in the prevalence of obesity, hypertension, diabetes, and abnormal placentation, among others, has fueled the recent rise in maternal mortality, "near misses" and severe morbidity. In 1976, the March of Dimes published a report, "Toward Improving the Outcome of Pregnancy," which included recommendations for levels of perinatal care. Although the original intent was to address the needs of both mother and neonate, implementation in the ensuing years focused mostly on the latter. Currently, there are no well-defined nationally accepted levels of maternal care similar to those adopted by the American Academy of Pediatrics for neonatal intensive care units. When discussing regionalization of perinatal care, the needs of the mother are frequently overlooked. We propose that it is time to address this deficiency and develop levels of care that are specific to the mother. We expect that improving maternal care will also improve neonatal outcome. We call on various organizations and agencies to establish national standards and levels of maternity care much as our colleagues in neonatology have already successfully done. We canvassed the available publications by states and other countries and found a number of noteworthy examples. We propose that the goal would be an integrated maternal-fetal-neonatal care network, a model similar to what is done in stroke or emergency care. In addition to accepting transfers, the central facility functioning at the highest level would also be responsible for education, evidence-based best practices, policy development, and quality review and improvement within the network.

AB - An increase in the prevalence of obesity, hypertension, diabetes, and abnormal placentation, among others, has fueled the recent rise in maternal mortality, "near misses" and severe morbidity. In 1976, the March of Dimes published a report, "Toward Improving the Outcome of Pregnancy," which included recommendations for levels of perinatal care. Although the original intent was to address the needs of both mother and neonate, implementation in the ensuing years focused mostly on the latter. Currently, there are no well-defined nationally accepted levels of maternal care similar to those adopted by the American Academy of Pediatrics for neonatal intensive care units. When discussing regionalization of perinatal care, the needs of the mother are frequently overlooked. We propose that it is time to address this deficiency and develop levels of care that are specific to the mother. We expect that improving maternal care will also improve neonatal outcome. We call on various organizations and agencies to establish national standards and levels of maternity care much as our colleagues in neonatology have already successfully done. We canvassed the available publications by states and other countries and found a number of noteworthy examples. We propose that the goal would be an integrated maternal-fetal-neonatal care network, a model similar to what is done in stroke or emergency care. In addition to accepting transfers, the central facility functioning at the highest level would also be responsible for education, evidence-based best practices, policy development, and quality review and improvement within the network.

UR - http://www.scopus.com/inward/record.url?scp=84866925471&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866925471&partnerID=8YFLogxK

U2 - 10.1097/AOG.0b013e31826af878

DO - 10.1097/AOG.0b013e31826af878

M3 - Article

VL - 120

SP - 929

EP - 934

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 4

ER -