Background

Rates of maternal mortality (death during or shortly after pregnancy) in the United States are elevated relative to those of peer nations and are especially high for Black women. Worse, trends for rates of maternal death have gotten worse over time and across racial and ethnic groups. the US increase in maternal morbidity may be tied to a rising prevalence of cardiovascular disease and associated risk factors – such as obesity, hypertension, metabolic syndrome, or diabetes – across American populations. Women of childbearing age have seen increases in the prevalence of these risk factors; in addition, many US women are giving birth at older ages, which may further compound risks.

What We Did

The Duke Department of Obstetrics and Gynecology team has deployed programs that track risk factors related to maternal morbidity in order to monitor trends and changes over time, including:

• Treatment of hypertension
• Hemorrhage prevention
• Care for pregnant patients with underlying heart disease.

We monitor trends in these data and engage directly with clinicians to understand any barriers that they may be experiencing to providing optimal, protocol-driven care. We then intervene to address these barriers in order to make providing the highest quality care as easy for the clinicians and staff as possible. The CACHE program has allowed us to perform a complex analysis of severe maternal morbidity in our high-risk patients in order to provide targeted intervention that will improve maternal and fetal health.

Next Steps

The Duke Department of Obstetrics and Gynecology is committed to decreasing maternal morbidity and narrowing health disparities in our community and across the nation. Since 2017, the department has developed numerous quality interventions aimed at improving care for all patients. We believe that standardizing care with careful monitoring and ongoing direct feedback to clinicians and staff will create continuous improvement in care for our patients.