The NC Maternal Mortality Review Committee Report has been posted. North Carolina has a long-standing history of reviewing pregnancy-associated deaths. The ultimate goal of the North Carolina MMRC is to apply information gathered during pregnancy-related death reviews to devise recommendations and strategies aimed at preventing pregnancy-related deaths in our state. Based on reviews of 2014-2016 pregnancy-related deaths, the MMRC identified a total of 188 recommendations.
More than a third (37%) of Committee recommendations were focused on providers, making it the most cited recommendation category. NC MMRC provider recommendations include those that focus on:
• Adherence with clinical guidelines and protocols – Examples of these recommendations included using maternity safety bundles, consideration of appropriate levels of maternal care, and adherence to clinical protocols for cardiac care, hypertension, vaccination administration, medical transport, hyperemesis, infection, maternal depression, trauma, pre/post-operative antibiotic prophylaxis, appropriate imaging, and sepsis.
• Coordination and communication between providers – In this category, recommendations included facilitation of timely referrals, implementation of virtual/telehealth services, and better communication and coordination between EMS, mental health, prenatal care and hospital providers.
• Education/Training – Examples of these recommendations included provider education/training on subjects such as sepsis management, HELLP symptoms, deep vein thrombosis, diagnostic equipment, treatment of chronic pain conditions, discriminatory practices based on weight, early warning signs, post-surgical risks of bariatric surgery, and simulation trainings. Providers were also encouraged to provide education to patients and families on topics such as the fourth trimester, pre/post-operative risk factors and complications, prescription drug compliance, sickle cell disease care, and deep vein thrombosis during the postpartum period.
• Patient screening and follow-up – Recommendations included promoting optimal postpartum follow-up after delivery discharge, postpartum depression screening, follow-up after miscarriage.
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From the NC Maternal Mortality Review Report