(720) Severe Maternal Morbidity Surveillance in Maryland: Trends Observed between 2021-2023

Data are from SMM surveillance for 2021-2023 among the 5 hospitals that participated over the full period (level III & IV birthing facilities in rural and urban settings). Using X² tests, we analyzed changes in primary cause of SMM, patient characteristics, and contributing factors. We further examined policy and practice changes that resulted from SMM reviews.

Results:

Of 428 SMM events identified and reviewed, 80%, 78%, and 86% of patients had preexisting comorbidities in 2021, 2022, and 2023, respectively (p=0.24). A growing proportion of patients did not receive prenatal care (1.6% in 2021, 5.4% in 2022, and 8.7% in 2023; p=0.035). Obstetric hemorrhage was the leading cause ( >50%) of SMM across all 3 years; however, the distribution of other causes varied (Table 1). COVID-19 was the second primary cause of SMM in 2021 (18%), but resulted in only 3 SMM events in 2022-23. Over the 3-year period, review committees determined that 37% (increasing from 34% to 40% between 2021 and 2023) of SMM events were preventable with changes to one or more provider, system, or patient factor. System and patient factors were identified in a larger percentage of preventable SMM events in 2023 than 2021-2022, while the contribution of provider factors did not change significantly (Table 2). In response to SMM reviews, all participating hospitals made specific policy and practice changes to address factors that contributed to leading causes of preventable SMM.

Conclusion: 40% of SMM events were deemed preventable by review committees in 2023. With hemorrhage being the leading cause of SMM, participating hospitals introduced policy and practice changes targeting hemorrhage and implementation of AIM’s Obstetric Hemorrhage bundle is underway in Maryland.