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U.S. Maternal Mortality Review Committee Composition: An analysis of membership profession and committee reports
Abstract Number: T1B-1
Abstract Type: Original Research
Introduction: Maternal mortality review committees (MMRC) serve an increasingly important role in characterizing maternal deaths and assessing preventability as the U.S. maternal mortality ratio climbs1. A CDC-led initiative has worked to standardize MMRC function and reporting2. We gathered MMRC membership data to characterize membership composition as recommended by key national health organizations.
Methodology: The departments of health of all 50 United States were emailed with requests to identify: 1) existence of a MMRC, 2) formation date, 3) list of committee member title and specialty, 4) the most recent maternal mortality report, 5) the pregnancy-related mortality rate (PRMR), 6) the percentage of pregnancy-related deaths (PRD) determined preventable, and 7) the most common causes of PRD. Email inquiries were followed-up with repeat email and phone calls until replies were received from all states. The primary outcome was percent of committees that meet membership recommendations from health organizations. Secondary outcomes include number and type of specialists on each MMRC and MMRC findings for leading causes of maternal mortality and preventability.
Results: Thirty-six states have MMRCs (Table). Two-thirds of MMRCs fail to meet membership recommendations of any health organization. The combined PRMR is 13.2; 50% of PRD were deemed preventable. Five professions account for 71% of committee members: department of health representative, obstetrician, nursing, maternal fetal medicine, and midwifery. Anesthesiologists are represented on half (n=18) of MMRCs.
Discussion: Membership of MMRCs is concentrated among few subspecialties and professions. Anesthesiologists have a small voice, despite their providing care for the majority of pregnant women and having critical care expertise. Cardiologists are even more rare, despite the increasing role of cardiovascular disease in maternal mortality. Finally, no committee had a patient advocate or representative.
1. St Pierre A, Zaharatos J, Goodman D, Callaghan WM: Challenges and Opportunities in Identifying, Reviewing, and Preventing Maternal Deaths. Obstet Gynecol 2018; 131: 138-142
2. Zaharatos J, St Pierre A, Cornell A, Pasalic E, Goodman D: Building U.S. Capacity to Review and Prevent Maternal Deaths. J Womens Health (Larchmt) 2017