The South Carolina Maternal Morbidity and Mortality Review (MMMR) Committee, established by state law in 2016, investigates the death of mothers associated with pregnancy to determine which ones can be prevented. A pregnancy related death occurs when a woman dies while pregnant or within 1 year of pregnancy. The cause is related to or made worse by her pregnancy or its management. This does not include accidental or incidental causes

South Carolina Maternal Morbidity and Mortality Review Committee

South Carolina State Documents Depository

South CarolinaMaternal Morbidityand MortalityReview CommitteeLegislative BriefMarch 2020The South Carolina Maternal Morbidity and Mortality Review (MMMR) Committee, established by state law in 2016,investigates the death of mothers associated with pregnancy to determine which ones can be prevented. A pregnancy-related death occurs when a woman dies while pregnant or within 1 year of pregnancy. The cause is related to or madeworse by her pregnancy or its management. This does not include accidental or incidental causes. VISION: To eliminate preventable maternal deaths, reduce maternal morbidities, andimprove population health for women of reproductive age in South Carolina.Across the United States, roughly 700 women dieeach year from the result of pregnancy or deliverycomplications.  Some groups of womenexperience this tragic event at a much higherrate than other groups.Between 2014 and 2018, 73 South Carolinawomen died within six weeks of giving birth, arate of 25.5 deaths per 100,000 live births. Thematernal mortality rate was 2.6 times higher forBlack and Other women versus White women(43.3. vs. 16.4 maternal deaths per 100,000 livebirths, respectively).South Carolina Maternal Mortality Rateby Race, 2014-2018Rate per 100,000 live births25.516.443.3South Carolina White Black & Other1008060402001233Determine the annual number ofpregnancy-associated deaths thatare pregnancy-related.Identify trends and risk factorsamong preventable pregnancy-related deaths in SC.Develop actionable strategies forprevention and intervention.GOALS:123Scope of Case Review for the South CarolinaMaternal Morbidity and MortalityReview CommitteePrimary Focuspreventable pregnancy-related deathspregnancy-associateddeathspregnancy-relateddeaths4WINS:CITATIONS:12CONCLUSIONS:The SC MMMR Committee found that the majority of maternal deaths reviewed were pregnancy-relatedand were related to complications of pregnancy and its management. Hemorrhage and infections wereidentified to be the leading causes of those deaths. The largest proportion of factors identified by the SCMMMR Committee as contributing to pregnancy-related deaths were patient/family factors followed byprovider and systems of care factors. On average, five contributing factors were identified for everypregnancy-related death.The SC MMMR Committee has had several successes since 2018, including the hiring of a full-time nurseabstractor, obtaining access to vital records for case identification, and joining the Centers for DiseaseControl and Prevention's centrally-hosted data entry system (MMRIA). These changes will help tostrengthen the existing efforts of the SC MMMRC, identify emerging issues, and highlight potentialopportunities for action.There are key decisions that the SC MMMR Committeemakes for each maternal death reviewed. These decisionsincrease understanding of the medical and non-medicalcontributors to maternal deaths and prioritizeinterventions that effectively reduce their occurrence.Between 2016 and 2019, there were 27 maternal deathsreviewed. The Committee findings are summarizedbelow.SC MMMR Committee FindingsHired full-time nurse abstractor.Strengthened legislation to enable linkageto vital records for improved caseidentification.Implemented central hosting of theMaternal Mortality Review InformationApplication (MMRIA) for standardized datacollection and reporting.1 274% of cases reviewed by the Committeewere determined to be pregnancy-related(n=20).3Hemorrhage and infections were theleading causes of pregnancy-relateddeaths.CommunityPatient/FamilyProvider Facility Systemsof CareYes No Unable toDetermineHemorrhageInfectionsCardiovascular andCoronary ConditionsAmniotic Fluid EmbolismCardiomyopathyMalignanciesPre-eclampsia andEclampsiaPulmonaryConditionsPregnancy-Related74%Pregnancy-Associated,but NOTPregnancy-Related22%Unable to Determine if Pregnancy-Related or -Associated4%55% of pregnancy-related deaths weredetermined to be preventable (i.e., therewas at least some chance to alter theoutcome).Factors related to the patient/familyand providers of care were the largestcontributors of pregnancy-relateddeaths.Berg, C., Danel, I., Atrash, H., Zane, S., & Bartlett, L. (2001). Strategies to reduce pregnancy-related deaths. from identification and review to action, 2001.Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Mayes, N., Johnston, E., ... & Barfield, W. (2019). Vital signs: pregnancy-related deaths, United States, 2011–2015, and strategies forprevention, 13 states, 2013–2017. Morbidity and Mortality Weekly Report, 68(18), 423.South Carolina Vital and Morbidity Statistics 2018. (2019, September). Retrieved from https://scdhec.gov/health/sc-public-health-statistics-maps/biostatistics-publications.3

Legislative brief

   South Carolina Maternal Morbidity and Mortality Review Committee  1 Legislative Brief March 2023 The South Carolina Maternal Morbidity and Mortality Review Committee (SCMMMRC), established by state law in 2016, investigates maternal deaths associated with pregnancy. Data are reported through vital records, voluntary reporting, and CDC notification.  A pregnancy-related (PR) death occurs when a person dies while pregnant or within one year of pregnancy from a pregnancy complication, a chain of events initiated by the pregnancy, or a condition made worse by the pregnancy.1    COVID-19 UPDATE BACKGROUND  The goals of the SCMMMRC are: 1) determine the annual number of pregnancy-associated (PA) deaths that are PR; 2) identify trends and risk factors among preventable PR deaths in SC; and 3) develop actionable recommendations for prevention and intervention. SCMMMRC reviews all maternal deaths that occur during pregnancy and up to 365 days following the end of the pregnancy regardless of the cause of death. Each death is reviewed using a standardized approach that includes investigating underlying causes of death, pregnancy-relatedness, preventability, circumstances and contributing factors surrounding the death. In 2022, the SCMMMRC completed the review of 66 deaths from 2019, 22 of these deaths determined to be PR (30%). Although all deaths are tragic, the focus of the SCMMMRC is PR deaths. In 2019 the SC Pregnancy-Related Mortality Ratio (PRMR) was 38.6 PR deaths per 100,000 live births, a 9.3% increase from 35.3 in 2018.  WINS • Extended post-partum Medicaid coverage to 12 months. • Hired social worker to conduct family interviews. • Added cardiology and forensic pathologist committee members. • Completed prioritized Covid-19 death reviews for 2020 and 2021.  VISION: To eliminate preventable maternal deaths, reduce maternal morbidities, and improve population health for people of reproductive age in South Carolina. • All COVID-19 deaths through 2021 were investigated. • 13 Pregnancy-associated deaths through 2021 were investigated by the SCMMMRC. o 10 deaths determined as PR o 80% Preventable • 100% Unvaccinated • 90% Post-Partum Period • 70% Obese • Advanced maternal age          The SCMMMRC committee supports and recommends COVID-19 vaccination for all pregnant or post-partum women. Providers caring for pregnant or post-partum women should educate, counsel, and convey the benefits of COVID-19 vaccination.  Pregnant women should not delay receiving the COVID-19 vaccination. COVID-19 medical interventions that include medications should not be withheld due to pregnancy.  RECOMMENDATIONS 2 3 4   2 In 2018 and 2019, over 70% of pregnancy-related deaths occurred during the post-partum period. The SCMMMRC recommends all birthing women have a post-partum checkup within 1-3 weeks after delivery, allowing clinical assessment and monitoring of medical and behavioral health conditions.  The top three underlying causes of maternal deaths for 2018 and 2019 were cardiomyopathy, mental health conditions and hemorrhage. The SCMMMRC defines mental health conditions as psychiatric disorders (such as depression), suicide, and substance use disorder. Combined, cardiomyopathy and cardiovascular conditions account for 1 in 4 PR deaths. The leading cause of death in non-Hispanic Blacks was cardiomyopathy, while mental health conditions were the leading cause of death for non-Hispanic Whites. In 2019, 81.8% of the pregnancy-related deaths investigated by the SCMMMRC were determined to be preventable. This aligns with the national statistic of 80%.3 A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes.  These changes may occur at the patient/family, provider, facility, system, or community level and may be associated with various contributing factors.  In SC, the non-Hispanic Black population experienced a 67% higher pregnancy-related mortality ratio than their White counterparts in 2018 and 2019. Both were higher than the United States PRMR of 17.3.2 The SCMMMRC recommendation is for hospitals and providers to recognize and address racism and improve the quality of care to birthing women of color. Individuals of color should receive equitable and comprehensive care before, during, and after pregnancy.  In 2018 and 2019, women who resided in rural South Carolina counties had a 70.4% higher rate of a pregnancy-related death than their urban counterparts. Medicaid was identified as the leading payor source for prenatal care and delivery of pregnancy-related deaths. 3 The possibility of discrimination is described as treating someone less or more favorably based on the group, class, or category they belong to resulting from biases, prejudices, and stereotyping. It can manifest as differences in care, clinical communication, and shared decision-making.4 Discrimination was recognized as a contributing factor in more than half of the pregnancy-related deaths reviewed. As maternal age increases, so does the risk of a pregnancy-related death. In 2018-2019, women over the age of thirty experienced a higher rate of pregnancy-related deaths than younger women. Individuals aged 40-44 were 3-4 times more likely to experience a PR death than their younger counterparts. 1 Heath Care Access - All birthing women should have an established primary care provider who can address chronic health, mental health conditions before, during and after pregnancy. 2 Clinical Intervention - All SC birthing hospitals should adopt hemorrhage protocols/safety bundles and educate providers and staff regarding hemorrhage recognition and management to include quantitative blood loss measurement, surgical management, ICU care and blood product administration. 3 Continuity of Care - All birthing women should have a post-partum appointment within 1-3 weeks following delivery. 4 Discrimination - Recognize and address racism and improve the quality of care to birthing women of color. Birthing women of color should receive equitable and comprehensive care during pregnancy and the post-partum period.  5 Referrals - Birthing women should receive referrals to appropriate medical specialties, and behavioral health providers. 6 Clinical Intervention - SC should support the education and training of obstetrical and emergency department medical and nursing staff, utilizing simulations of obstetrical emergencies and training seminars focusing on hemorrhage, high blood pressure, cardiovascular conditions, and mental health conditions.   7 Discrimination - All SC hospitals and obstetric providers should utilize interpretative services to assist birthing women when English is not their primary language. 8 Clinical Intervention - All birthing women should have Screening, Brief Intervention, Referrals and Treatment (SBIRT) screenings for mental health and be screened for substance use, domestic violence, and chronic disease at the initial prenatal appointment, during pregnancy and at post-partum follow up appointments.  Committee Recommendations for Reducing Pregnancy-Related Deaths in South Carolina The South Carolina Maternal Morbidity and Mortality Review Committee was asked to prioritize recommendations in order of importance to prevent pregnancy-related deaths. SUMMARY The SCMMMRC is committed to the elimination of preventable pregnancy-related deaths. The committee acknowledges that the PRMR is higher in SC than the national average, especially among non-Hispanic Black mothers and birthing women. The SCMMMRC is actively working through its partners and stakeholders to address the health and healthcare needs of birthing women and to leverage existing resources to support continued education and training among providers and payors. Citations 1. Maternal Mortality Review Committee Decisions Form. Retrieved from https://reviewtoaction.org/national-resource/mmria-committee-decisions-form-and-additional-guidance  2. Centers for Disease Control and Prevention (CDC). (2020,November). Pregnancy Mortality Surveillance System. Retrieved formhttps://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm. 3. Pregnancy Related Death: Data from Maternal Mortality Revie Committees in 36 States, 2017-2019. Retrieved from https://reviewtoaction.org/tools/resource-center 4. Smedley et al, 2003 and Dr. Rachel Hardeman CR-013357    4/20234 

English

Legislative BriefMarch 2021VISION: To eliminate preventable maternal deaths, reduce maternal morbidities, andimprove population health for women of reproductive age in South Carolina.Across the United States, roughly 700 women dieeach year from the result of pregnancy or deliverycomplications.  Some groups of womenexperience this tragic event at a much higherrate than other groups.Between 2015 and 2019, 75 South Carolina womendied within six weeks of giving birth, a rate of 26.2deaths per 100,000 live births. The maternalmortality rate was 2.4 times higher for Black andOther women versus White women (42.3. vs. 18.0maternal deaths per 100,000 live births,respectively).South Carolina Maternal Mortality Rateby Race, 2015-2019Rate per 100,000 live births26.218.042.3South Carolina White Black & Other1008060402001233Determine the annual number ofpregnancy-associated deaths that arepregnancy-related.Identify trends and risk factors amongpreventable pregnancy-related deathsin SC.Develop actionable recommendationsfor prevention and intervention.GOALS:123Scope of Case Review for the South CarolinaMaternal Morbidity and MortalityReview CommitteePrimary Focuspreventable pregnancy-related deathspregnancy-associateddeathspregnancy-relateddeathsSouth Carolina MaternalMorbidity and MortalityReview CommitteeThe South Carolina Maternal Morbidity and Mortality Review (MMMR) Committee, established by state law in 2016,investigates the death of mothers associated with pregnancy to determine which ones can be prevented. A pregnancy-related death occurs when a woman dies while pregnant or within 1 year of pregnancy. The cause is related to or madeworse by her pregnancy or its management. This does not include accidental or incidental causes. There are six primary decisions that the SC MMMRCommittee makes for each maternal death reviewed.These decisions increase understanding of the medicaland non-medical contributors to maternal deaths andprioritize interventions that effectively reduce theiroccurrence.Between 2016 and 2020, there were 63 maternal deathsreviewed. Of which, 60 were within the scope of casereview. The Committee findings are summarized below.SC MMMR Committee Findings1 262% of maternal deaths reviewed by theCommittee were determined to be pregnancy-related (n=37).Hemorrhage and cardiovascular andcoronary conditions were the leadingcauses of pregnancy-related deaths.Pregnancy-Associated,but NOTPregnancy-Related33%Unable to Determine ifPregnancy-Related or -Associated5%Conditions Uniqueto PregnancyPulmonaryConditionsMalignanciesHemorrhageCardiovascular andCoronary ConditionsCardiomyopathyInfectionsAmniotic FluidEmbolismPre-eclampsia andEclampsiaThrombotic Embolisms368% of pregnancy-related deaths weredetermined to be preventable (i.e., there wasat least some chance to alter the outcome).CommunityPatient/Family Provider FacilitySystemsof CareContributing factor classifications vary intheir distribution within the leadingcauses of pregnancy-related death.4Preventable68%Not Preventable30%A preventable pregnancy-related death is defined by a"yes" response to preventability or where at least somechance to alter the outcome was noted.Black maternal deaths accounted for 43% ofall pregnancy-related deaths reviewed between 2016and 2020 (White, 27%; Other, 8%, Unknown, 22%).Disparate causes of death were observed by race -hemorrhage was the most common cause of Blackmaternal deaths, while infection and cardiomyopathywere tied as the leading cause of White maternaldeaths.The immediate postpartum period is the mostvulnerable period for women of all races.Distribution of Pregnancy-Related Deaths byTiming of Death in Relation to PregnancyRacial Disparities in Pregnancy-Related DeathsWhilePregnant11%Within42 Days70%43 Daysto 1 Year14%*Pregnancy-related deaths where timing wasunknown were excluded (2).22%Pregnancy-Related62%19%16%14%8%8%5%3%3%3%Unable to Determine3%All Causes Hemorrhage Cardiovascularand CoronaryConditionsWINS:Increased capacity to abstract and reviewmaternal deaths.Instituted a linkage process with vital recordsfor case ascertainment.Established a specialized subcommittee toreview maternal deaths that are broader inscope (i.e., pregnancy-associated).Transitioned from "local hosting" to "centralhosting" of the data management system forstandardization across states and jurisdictions.Committee Recommendations and ImpactSC should expand Medicaid to cover 12 months postpartum; this will allow for comprehensivemedical care and will reduce racial disparities that occur in SC with regards to maternalmortality.SC should address racism and improve the quality of care provided to women of color. Women ofcolor should receive equitable and comprehensive care during the pregnancy and postpartumperiod.All SC hospitals should adopt hemorrhage protocols and educate providers and staff regardinghemorrhage recognition and management to include adequate surgical management, ICU careand blood product administration.SC should increase the use of OB Care Coordinators/Navigators who would link women toappropriate medical, mental health, and social services.Women who have preexisting coronary artery disease/cardiac conditions or a newly diagnosedcardiovascular condition should receive referrals to advanced obstetric care (Maternal FetalMedicine) and Cardiology.All SC hospitals and obstetric providers should utilize interpretative services to assist womenwhen English is not their primary language.SC should continue to support the education and training of medical and nursing staff utilizingsimulations of obstetrical emergencies.5 What can be done to reduce pregnancy-related deathsin South Carolina moms?CITATIONS:12CONCLUSIONS:The SC MMMR Committee found that nearly two out of three women who died during pregnancyor within the first year of pregnancy died from a cause directly related to pregnancy or its management.From the deaths reviewed, hemorrhage and cardiovascular and coronary conditions were identified asthe two leading causes of pregnancy-related deaths. The largest proportion of factors found to contributeto hemorrhage deaths include provider, systems of care, and facility factors. Conversely, patient/familyand systems of care factors were tied as largely contributing to deaths due to cardiovascular andcoronary conditions.South Carolina recognizes the health inequities faced by the state's racially diverse population and thoseliving in rural communities. The addition of committee recommendations to this report highlights thework that is most needed to meet our goals. The successes achieved in the past year by the Committeeunderscores the state's commitment to close the gaps in access and services for all women and tostrengthen quality improvement efforts. Just as important to this work is understanding the role ofracism and discrimination in pregnancy and birth outcomes and how collective, targeted upstream anddownstream approaches are needed to ameliorate their effects.Berg, C., Danel, I., Atrash, H., Zane, S., & Bartlett, L. (2001). Strategies to reduce pregnancy-related deaths. from identification and review to action, 2001.Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Mayes, N., Johnston, E., ... & Barfield, W. (2019). Vital signs: pregnancy-related deaths, United States, 2011–2015, and strategies forprevention, 13 states, 2013–2017. Morbidity and Mortality Weekly Report, 68(18), 423.South Carolina Vital and Morbidity Statistics 2019. (2020, November). Retrieved from https://scdhec.gov/sites/default/files/media/document/Vital-Morbidity-Statistics_2019.pdf.Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. Retrieved fromhttp://reviewtoaction.org/Report_from_Nine_MMRCs346 What Level of Impact is Anticipated ifRecommendations are Implemented?Health Impact PyramidHelps to prioritizeand translaterecommendationsto action4Giantaddress social determinants of healthExtra Largechange in contextLargeMediumSmalllong-lastingprotectiveinterventionsclinicalintervention andcoordination ofcareeducation andcounselingSmall Medium Large ExtraLarge15%50%29%6%

1South Carolina MaternalMorbidity and MortalityReview CommitteeLegislative BriefMarch 2022VISION: To eliminate preventable maternal deaths, reduce maternal morbidities, and improve population health for women of reproductive age in South Carolina.Across the United States, roughly 700 women die each yearfrom the result of pregnancy or delivery complications. Somegroups of women experience this tragic event at a much higherrate than other groups. There are six primary decisions that the SC MMMRCommittee makes for each maternal death reviewed.These decisions increase understanding of the medical andnon-medical contributors to maternal deaths and prioritizeinterventions that effectively reduce their occurrence. The SC MMMR Committee recently established asubcommittee to review pregnancy-associated deaths,or deaths temporally-related to pregnancy, and to determinewhich deaths were potentially made worse by the pregnancyor its management and should be reviewed by the fullcommittee. Beginning in 2021, the subcommittee expeditedthe review of maternal deaths impacted by COVID-19. In 2021, the SC MMMR Committee completed the review ofPR deaths occurring in 2018 which resulted in the first reportof the South Carolina Pregnancy-Related Mortality Ratio(PRMR) - 35.3 pregnancy-related deaths per 100,00 livebirths in 2018. Although higher than the U.S. PRMR of 17.3,the SC MMMR Committee is actively working through itspartners and stakeholders to address the health and healthcare needs of women and leverage existing resources tosupport continued education and training among providersand payors.The South Carolina Maternal Morbidity and Mortality Review (MMMR) Committee, established by state law in2016, investigates the death of mothers associated with pregnancy to determine preventability. A pregnancy-related(PR) death occurs when a woman dies while pregnant or within one year of pregnancy. The cause is related to ormade worse by her pregnancy or its management. This does not include accidental or incidental causes.GOALS:BACKGROUNDDetermine the annual number ofpregnancy-associated deaths that arepregnancy-related.Identify trends and risk factors amongpreventable  pregnancy-related deaths inSC.Develop actionable recommendations forprevention and intervention.23Scope of Case Review for the South CarolinaMaternal Morbidity and MortalityReview Committeepregnancy-associateddeathspregnancy-relateddeathsPrimary Focuspreventable pregnancy-related deaths21Leading Causes of Pregnancy-Related Deaths*Hemorrhage, cardiovascular conditions, andinfection were the three leading causes of PR deathsreviewed between 2016 and 2021. Conditions of theheart, its muscle, and blood vessels constitute morethan 1 in 4 PR deaths (cardiovascular conditions andcardiomyopathy combined). Mental health conditions and infection were theleading causes of PR deaths in 2018. Hemorrhage,infection, and cardiomyopathy were tied as theleading cause of PR death in non-Hispanic Blackwomen, while infection was the prominent cause ofPR death in non-Hispanic White women (not shown)Legislative BriefMarch 2022WINS:1Percent (%)51%43%6%41%51%8%Pregnancy-Related Pregnancy-Associated, but NOT -RelatedPregnancy-Associatedbut Unable toDetermine Pregnancy-Relatedness02550Between 2016 and 2021, there were 112pregnancy-associated deaths reviewed by the SCMMMRC or subcommittee, of which 51% (n=57)were determined to be pregnancy-related. Therewere 49 maternal deaths reviewed from 2018. Ofwhich, 41% (n=20) were determined to bepregnancy-related. Maternal deaths to non-Hispanic Black womenaccounted for 42% of all PR deaths(non-Hispanic White, 28%; Hispanic, 9%; Other,3%; Unknown, 17%; not shown).Pregnancy-Related Determination of Maternal DeathsPR Deaths  Reviewed to Date 2018 PR DeathsThe SC MMMRC established its subcommittee toreview pregnancy-associated deaths andexpedited the review of those  impacted byCOVID-19. In 2021, SC completed the review of PR deathsoccurring in 2018 which resulted in the first reportof the South Carolina Pregnancy-Related MortalityRatio (PRMR) - 35.3 pregnancy-related deaths per100,000 live births in 2018.2Percent (%)17%16%16%12%7%5%10%20%15%20%HemorrhageCardiovascularConditionsInfectionCardiomyopathyMental HealthConditions0 5 10 15 20 25MORE THAN 100 CHILDREN AND FAMILIESARE IMPACTED BY LOSS.Distribution of Pregnancy-Related Deaths by Timing of Deathin Relation to PregnancyWhilePregnantWithin42 Days43 Daysto 1 Year23% 60% 17%*Percentages shown do not sum to 100%.PR Deaths  Reviewed to Date 2018 PR Deaths23The determination of preventability highlights thecritical and unique role of the SC MMMR Committee tospur actions that will lead to the reduction inpreventable pregnancy-related deaths. Overall, nearlythree in four (72%) PR deaths reviewed by theCommittee were determined to be preventable.Among PR deaths that occurred in 2018, 75% weredetermined to be preventable.Preventability of Pregnancy-Related DeathsPR DeathsReviewed to DatePercent (%)2018 PR DeathsContributing Factor Classifications among Pregnancy-Related Deaths4Percent (%)12%21%25% 25%2%26%22%12%30%0%29%31%4%12%10%Patient/Family Provider Facility Systems Community02040Preventable Not PreventableUnable to Determine72%75%26%25%2%The SC MMMR Committee identified an average of 4 factors for every pregnancy-related death. Facility andsystems-level factors accounted for 50% of all contributing factors for deaths due to hemorrhage. Systems-levelfactors also accounted for 30% of all contributing factors for deaths due to cardiovascular conditions, while providerfactors comprised 31% of all contributing factors for deaths due to infection. The Committee identified delay in treatment or patient care, clinical skill and quality of care, access and financialconstraints, policies and procedures, and continuity of care and care coordination as areas of improvement acrossthe more prominent factor levels.SPECIAL CIRCUMSTANCES                Discrimination              Obesity               Substance Use Disorder              Mental HealthPercent (%)52%24%20%16%Discrimination *ObesitySubstance UseDisorderMental HealthConditons0 20 40 60The SC MMMR Committee makes determinationsaround the circumstances of each pregnancy-related death.  Discrimination was recognized as acontributing factor in more than half of allpregnancy-related deaths reviewed. Similarly,obesity (24%), substance use disorder (20%), andmental health conditions (16%) were identified ascontributing factors .* Discrimination was added to the committee decisionsform in May 2020;  therefore, discrimination was onlyassessed in 36 of the 57 pregnancy-related deathsreviewed to date.Did the following factors contribute to PR deaths?InfectionPR Deaths due to: Hemorrhage Cardiovascular Conditions3long-lastingprotectiveinterventionsLarge5Committee Recommendations for Reducing Pregnancy-RelatedDeaths in South Carolina?6The Expected Level of Impact AfterImplementing Recommendations13%50%29%5% 3%Small Medium Large Extra Large Giant0255075Health Impact PyramidHelps to prioritize and translate recommendations to actionclinicalinterventionsandcoordination ofcareeducation andcounselingGiantaddress social determinants of healthExtra Largechange in contextMediumSmallLarge3Building U.S. Capacity to Review and Prevent Maternal Deaths. (2018). Report from nine maternal mortality review committees. Retrievedfrom http://reviewtoaction.org/Report_from_Nine_MMRCs1 Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Mayes, N., Johnston, E., ... & Barfield, W. (2019). Vital signs: pregnancy-related deaths, United States, 2011–2015,and strategies for prevention, 13 states, 2013–2017. Morbidity and Mortality Weekly Report, 68(18), 423.Centers for Disease Control and Prevention (CDC). (2020, November). Pregnancy Mortality Surveillance System. Retrieved fromhttps://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm.23COORDINATIONOF CAREAND REFERRALS4Women who have pre-existing coronary artery disease/cardiac conditions or a newly diagnosedcardiovascular condition should receive referrals to advanced obstetric care (Maternal Fetal Medicine) andCardiology.OB Care Coordinators/Navigators should link women to appropriate medical and mental health services,assist in establishing access to care, and assist in obtaining social services.All women with a history of moderate to severe mental health conditions and/or substance use disordershould have a referral to a behavioral health specialist and advanced maternal care/Maternal Fetal Medicine.  All SC birthing hospitals should adopt hemorrhage protocols/safety bundles and educate providers and staffregarding hemorrhage recognition and management to include quantitative blood loss measurement, surgicalmanagement, ICU care and blood product administration.SC should support the education and training of Obstetrical and Emergency medical and nursing staff utilizingsimulations of obstetrical emergencies, and training seminars.Providers should consider administering monoclonal antibody and other contemporary treatments, ifappropriate, as an option for pregnant and post-partum women.Recognize and address racism and improve the quality of care provided to women of color. Women of colorshould receive equitable and comprehensive care during pregnancy and the post-partum period.All SC hospitals and obstetric providers should utilize interpretative services to assist women when English isnot their primary language.SC should expand Medicaid to cover 12 months postpartum; this will allow for comprehensive medical careand will reduce racial disparities that occur in SC with regards to maternal mortality.All women should have an established primary care provider who can address chronic health and mentalhealth conditions before, during, and after pregnancy.All women should have universal screenings for mental health, substance use, domestic violence, and chronicdisease at the initial prenatal appointment, during pregnancy, and at postpartum follow-up careappointments.All women should have a postpartum appointment within 1-3 weeks following delivery. Telehealthappointments are a viable alternative if an in-person appointment is not feasible.Providers caring for pregnant and post-partum women should educate, counsel, and support the benefits ofthe COVID-19 vaccination.CLINICALINTERVENTIONDISCRIMINATIONAND UNEQUALTREATMENTHEALTH CAREACCESSPRECONCEPTION,PERINATAL, ANDPOSTPARTUMHEALTH

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South Carolina State Documents Depository

South Carolina State Documents Depository

South Carolina State Documents Depository

South Carolina State Documents Depository