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MATERNAL
MORTALITY

FIGURE 1 www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html
provided obstetric services to implement
Maternal Early Warning Signs (MEWS)
protocols to provide early identification of
pregnant women at high risk for maternal
morbidity and mortality.
In 2014, the 83rd Texas Legislature, dur-
ing regular session, passed House Bill 15
establishing a process for designation of
neonatal and maternal levels of care for
health care facilities in Texas. In March of
this year the final maternal rules were pub-
lished and maternal delivery facilities from
around the state are actively preparing for
site surveys to meet maternal designation
deadline of September 1, 2020. This initia-
tive has great promise to improve care for
pregnant women in our state and to ensure
that each center has critical processes in
place for identification and care for women
with pregnancy complications. The desig-
of obstetric hemorrhage was 129.8/10,000 deliveries with dissem- nation process will help to ensure women who develop pregnancy
inated intravascular coagulopathy occurring in 25.8/10,000 deliver- complications are cared for at the appropriate level of care for their
ies, cardiac events occurring in 20.4/10,000 deliveries, emergency condition. The Texas Maternal Mortality and Morbidity Task Force
hysterectomy occurring in 13.9/10,000 deliveries, and eclampsia oc- was also created in 2013 through Senate Bill 495. This multidisci-
curring in 7.1/10,000 deliveries. These severe morbidities represent plinary task force reviews cases of pregnancy-related deaths and
potential “near misses” for maternal mortality and efforts to prevent trends in severe maternal morbidity and makes formal recommen-
these untoward outcomes represent key targets for efforts to reduce dations to the Texas Legislature for efforts to help reduce the inci-
maternal mortality in Texas and nationally. In a publication by Main dence of pregnancy-related deaths and severe maternal morbidity
and colleagues in Obstetrics & Gynecology in 2015, it was noted in Texas. Last summer as an extension of these state efforts, the
that there was a good-to-strong chance to prevent maternal death Bexar County Metropolitan Health District formed a Bexar County
in 41 percent of cases, with the highest rates of preventability Morbidity and Mortality Task Force composed of a diverse array
among cases of hemorrhage (70%) and preeclampsia (60%). of stakeholders from San Antonio and Bexar County to explore
local factors related to these adverse events.
Texas Initiatives to Prevent Maternal Morbidity In January of this year, Texas became an official member of the
and Mortality: Alliance for Innovation on Maternal Health (AIM) as part of the
We are fortunate today that there are a number of efforts under- Council on Patient Safety in Women’s Health Care. AIM is a national
way in Texas to address the scourge of maternal morbidity and mor- data-driven maternal safety and quality improvement initiative fo-
tality. Ongoing initiatives such as Healthy Texas Women, Someday cused on improving maternal safety and outcomes. Obstetric care
Starts Now, Preconception Peer Education Program, One Key bundles and toolkits are promoted to optimize maternal care
Question, and others have been implemented to provide increased through four main focal areas: Readiness, Recognition and Preven-
access and education to patients related to family planning and op- tion, Response, and Reporting/Systems learning. Since the launch
timal pregnancy preparation. The Texas Electronic Vital Events of TexasAIM in January, as of June 8, 2018, a total of 172 of the
Register (TxEVER) program is also underway to increased death 239 hospitals (72%) providing obstetric care in Texas have enrolled
certificate accuracy. The Texas Collaborative for Health Mothers to participate in AIM. Previous work through AIM has demon-
and Babies (TCHMB) was formed as a state perinatal collaborative strated that implementation of patient safety bundles can result in
in 2013 and has the mission to advance health care quality and pa- a significant decrease in severe maternal morbidity.
tient safety for all Texas mothers and babies. The collaborative has Finally, in September of last year the Texas Medical Association
undertaken state quality improvement initiative to assist hospitals convened a forum focused on the issue of maternal morbidity and
continued on page 18
visit us at www.bcms.org 17