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J Matern Fetal Neonatal Med. 2019 Nov 19:1-10. doi: 10.1080/14767058.2019.1686472. [Epub ahead of print]

Two decades of interventions in New York State to reduce maternal mortality: a systematic review.

Author information

1
NYU Langone Health, New York, NY, USA.
2
Weill Cornell Medical College, Cornell University, New York, NY, USA.
3
Saving Mothers, New York, NY, USA.
4
Maternal Fetal Medicine Associates PLLC, New York, NY, USA.

Abstract

Objective: To perform a systematic review of interventions to reduce maternal mortality in New York.Study design: We conducted a systematic review of literature published between 2000 and January 2019 reporting interventions to reduce maternal mortality in New York using PubMed and search terms: pregnancy-related death or maternal mortality OR maternal death AND New York. Eight hundred and ninety-three articles were reviewed by title, content, and focus on New York interventions or policies. Ten met inclusion criteria. A second review of the Safe Motherhood Initiative (SMI) identified an additional six articles.Results: Nine articles described hospital-based initiatives; one described a community-based initiative. No prospective randomized controlled trials in a nonsimulated setting were identified. Several articles described SMI bundles; one tested simulated checklist implementation. Three presented results of bundle implementation but did not significantly impact measured maternal mortality and/or morbidity. The single community-based initiative provided doulas to low-income women, yielding significantly lower rates of preterm birth and low birthweight, but no difference in cesarean deliveries compared to other women in the community.Conclusion: Current hospital-based interventions have not reduced maternal mortality in New York. The single community-based intervention identified reduced adverse birth outcomes. Continued concern about maternal mortality in New York suggests community-based approaches should be considered to affect change in conjunction with longer term hospital-based interventions.

KEYWORDS:

Community-based; Safe Motherhood Initiative; interventions; maternal death; maternal mortality

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