Executive Summary Report from Nine Maternal Mortality Review Committees 2018 from the CDC

Approximately 700 women across the United States (U.S.) die each year as a result of pregnancy or pregnancy-related complications. Non-Hispanic black women experience maternal deaths at a rate three to four times that of non-Hispanic white women, a racial disparity that is mirrored across many maternal and infant outcomes. 
Nearly 50% of all pregnancy-related deaths were caused by hemorrhage, cardiovascular and coronary conditions, cardiomyopathy, or infection. The leading underlying causes of death varied by race. Preeclampsia and eclampsia, and embolism were leading underlying causes of death among non-Hispanic black women. Over a three-year period, the United Kingdom had only two deaths from preeclampsia and eclampsia, suggesting deaths from these hypertensive disorders of pregnancy are highly preventable. 
Mental health conditions were a leading underlying cause of death among non-Hispanic white women, reinforcing the value of MMRCs including mental health-related maternal deaths in the scope of their review, and having access to information beyond death certificates. 
The Nine Committees estimated that over 60% of pregnancy-related deaths were preventable. The most common factors identified as contributing to the death were patient/family factors (e.g., lack of knowledge on warning signs and need to seek care) followed by provider (e.g., misdiagnosis and ineffective treatments) and systems of care factors (e.g., lack of coordination between providers). While the Nine Committees most commonly identified patient factors, the patient factors identified are often dependent on providers and systems of care. 
For the first time, the Nine Committees provided analyzable recommendations to prevent future maternal deaths and the estimated level of potential impact if those recommendations were implemented. 
The following were the most common recommendation themes that the Nine Committees also estimated to have the largest potential for population-level impact if implemented: adopting levels of maternal care, improving policies regarding prevention initiatives, enforcing policies and procedures related to obstetric hemorrhage, and improving policies related to patient management. 
Social and environmental factors may also contribute to a woman’s risk of dying during or within one year of pregnancy. MMRCs can incorporate contextual social determinants of health into case discussions, and translate findings into specific recommendations. This report is a demonstration of MMRCs’ potential to address health equity as a strategy to reduce maternal mortality and severe maternal morbidity. 
To turn the tide on maternal mortality in the U.S. we must build on current momentum and support the critical work of MMRCs. State- and local-level MMRCs can be the gold standard for understanding why preventable maternal deaths continue to occur and to prioritize ways to effectively reduce maternal deaths. As more MMRCs are able to share data, there will be greater understanding and specificity of potential high impact recommendations. These recommendations for action will be beneficial for public health and clinical care decision-makers as they design strategies to eliminate preventable maternal deaths at the local, state, regional and national levels. Describing recommendations for each of the leading causes of death is an important step forward; determining the potential of a recommendation to prevent maternal deaths remains an important opportunity for the future.