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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.

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


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.


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

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