Each year in the United States, it is estimated that 700 to 900 women die from pregnancy or complications related to pregnancy (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018). For each maternal death, there are likely 70 other women who suffered severe maternal morbidity (Ellison & Martin, 2017). Most experts agree that many of these events could have been prevented (American College of Obstetricians and Gynecologists [ACOG] & Society for Maternal-Fetal Medicine [SMFM], 2016). Review of these cases offers insight on commonalities, most frequent causes, and potential actionable lessons that can be preventative for future childbearing women.

Non-Hispanic Black women are more likely than White or Hispanic women to have severe maternal morbidity or maternal mortality. The Centers for Disease Control and Prevention (CDC, 2017) reports major racial disparities in maternal mortality. During 2011 to 2013, the pregnancy-related maternal mortality ratios were 12.7 deaths per 100,000 live births for White women, 43.5 deaths per 100,000 live births for Black women, and 14.4 deaths per 100,000 live births for women of other races. Data from maternal mortality review committees in nine states indicate hemorrhage, cardiovascular and coronary conditions, cardiomyopathy, and infection are leading causes of all maternal deaths in the United States; however, preeclampsia, eclampsia, and embolism are more common among non-Hispanic Black women (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018). There is no consensus on a definition of severe maternal morbidity. Examples of severe maternal morbidity offered by ACOG and SMFM (2016) include various types of hemorrhage, hypertension, renal disease, sepsis, pulmonary, cardiac, surgery, and anesthesia complications, and conditions requiring intensive care and invasive monitoring.

All cases of severe maternal morbidity and maternal mortality should be reviewed by an interdisciplinary quality committee. Criteria for identifying cases for review of severe maternal morbidity have been offered by ACOG and SMFM (2016) and include transfusion of four or more units of blood and admission of a pregnant or postpartum woman to an intensive care unit. Evaluation of the process of care such as timely and appropriate diagnosis and treatment can be extremely useful in developing plans for improvement and potentially preventing a subsequent similar case.

Findings from the nine maternal mortality review committees suggest there are common contributing factors (Building U.S. Capacity to Review and Prevent Maternal Deaths, 2018). They include patients' lack of knowledge on warning signs and the need to seek care, healthcare provider misdiagnosis and ineffective treatments, and systems of care factors such as lack of coordination between providers. Based on these data, the review committees offered a number of recommendations specific to common causes of death. Overall recommendations included adopting levels of maternal care (ACOG & SMFM, 2015), enhancing prevention initiatives, enforcing policies and procedures on obstetric hemorrhage, and improving policies about patient management. Participating in reviews of severe maternal morbidity and maternal mortality at the facility level and as part of a state review committee are opportunities for nurses to be involved as active members in significant efforts to understand causation and develop prevention strategies. Together we must do better in preventing these types of adverse events.

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