Introduction

Emergency Obstetric Care (EmOC) refers to a set of life-saving medical interventions provided to women experiencing complications during pregnancy, childbirth, or within 42 days after delivery. These interventions include the management of severe bleeding, eclampsia, obstructed labor, infections, and other obstetric emergencies. EmOC services are typically provided in health facilities equipped to perform signal functions, which indicate the facility’s capacity to respond effectively to obstetric complications (WHO, 2009)’. Over the past 15 years, these signal functions have served as a framework for assessing the availability, quality, and use of EmOC services, thereby laying the foundation for global health improvement.

Global Progress in Maternal Mortality

Since the 2009 inception and implementation of the Monitoring Emergency Obstetric Care handbook, maternal health outcomes have improved globally. Maternal mortality has declined worldwide, but disparities remain across regions and populations. Timely and effective EmOC can prevent up to 74% of maternal deaths.

• United States:
• 2022: Maternal mortality rate of 22.3 deaths per 100,000 live births.
• 2023: Decreased to 18.6 deaths per 100,000 live births, totalling 669 maternal deaths (CDC, 2023).
• Disparities:
• women aged 40+: 59.8 deaths per 100,000 live births.
• black women: 50.3 deaths per 100,000 live births (CDC, 2023)
• Eastern Europe: 75% reduction in maternal mortality ratio (MMR), from 38 to 9 per 100,000 live births.
• Southern Asia: 71% decline, from 405 to 117 per 100,000 live births.
• Sub-Saharan Africa: 40% reduction, from 454 to 273 per 100,000 live births.
• Central & Southern Asia: Lifetime risk of maternal death fell 83%, from 1 in 71 to 1 in 410.

Maternal Mortality and the Sustainable Development Goals (SDGs)

SDG 3.1 calls for a reduction in global MMR to less than 70 per 100,000 by 2030, and no country should have an MMR greater than 140 per 100,000. ‘As 2030 approaches, it is critical to intensify coordinated efforts and mobilize global, regional, national, and community-level commitments to end preventable maternal mortality (WHO, 2023). Between 2000 and 2023, the global maternal mortality ratio (MMR) decreased by 40%, from 328 to 197 deaths per 100,000 live births, representing an average annual decline of 2.2%.’ To meet SDG 3.1 by 2030, the global MMR will need to decline by nearly 15% per year over the next seven years.

Key Innovations in Emergency Obstetric Care

Despite global reductions in MMR, progressive care in EmOC is critical to achieve SDG targets. The following innovations have strengthened preparedness and responsiveness during emergencies.

• Rapid access to well-functioning emergency obstetric facilities that meet high-quality care standards
• Regular training and simulation-based practices of healthcare providers enhance effective management of obstetric emergencies. The American Academy of Family Physicians developed Advanced Life Support in Obstetrics (ALSO) and is used worldwide.
• The implementation of the “3 Delays” Model, delay in seeking care, delay in reaching care, and delay in receiving appropriate care in health facilities, helps identify and mitigate the barriers to timely and effective care, and can significantly reduce maternal mortality.
• Integration of EmOC into health systems, e.g., strengthening of referral systems, availability of medications, and equipment
• Early Warning Systems are integrated and structured tools for quick recognition of obstetric deterioration. It helps to avoid life-threatening complications and is proven to lower maternal mortality. The Modified Early Obstetric Warning Score (MEOWS), the California Maternal Quality Care Collaborative (CMQCC) Hemorrhage Risk Assessment & Checklist, and other U.S.-based tools are examples that identify women at risk for postpartum hemorrhage and guide rapid intervention. In high-resource areas, EWS are integrated with electronic health records, while in low-resource settings, paper-based charts are used.

Quality Improvement of the Health System

• National policies support standardized, evidence-based care
• Upgrade of facilities to meet the standards of EmOC
• Continuous professional development ensures that healthcare providers adhere to signal function protocols.

Ongoing Challenges

Despite progress in reducing maternal mortality rates through EmOC, some challenges persist:

• Health-worker burnout: Few health personnel to manage emergency cases
• Gaps in Equitable Care: Low-resource regions still face high maternal mortality.
• Variable Quality: Facilities may meet basic standards but lack patient-centered care.
• Resource Limitations: Personnel, equipment, and essential supplies remain insufficient in some areas.

Future Directions

• Evidence-based clinical care: Scaling up bundles for postpartum hemorrhage, hypertensive emergencies, and sepsis, along with 24/7 surgical readiness and safe anesthesia.
• Data-driven policy & innovation: Maternal Death Surveillance & Response, supply-chain intelligence, and research into AI-assisted triage to support evidence-based improvements
• Maternal and Perinatal Death Surveillance and Response (MPDSR),2021, by WHO, is a practical step-by-step guidance for conducting MPDSR in clinical and policy settings. It helps to generate modifiable risk factors of preventable maternal deaths and use the information as a guide in decision-making to prevent similar future deaths.
• AI holds significant potential to reduce maternal morbidity and mortality. Examples of AI-based tools include PeriGen’s predictive fetal monitoring software, clinical decision support systems (CDSS) that flag high-risk pregnancies, and machine learning algorithms that analyze patient data to predict adverse outcomes such as preeclampsia or postpartum hemorrhage. They are proving to be effective in the early prediction of gestational complications, clinical decision-making, and the continuous monitoring of women in prenatal and postpartum care.

Conclusion

The 2009 WHO Monitoring EmOC Handbook has served as a transformative framework for global maternal health practices. While significant progress has been made in reducing maternal mortality, sustained investment and innovation in equitable and quality care, technology, health professional development, and a robust surveillance system remain essential. Ongoing commitment to EmOC is a critical step toward achieving universal safe maternal care by 2030.

References

1.World Health Organization. Monitoring Emergency Obstetric Care: A Handbook. Geneva: WHO;2009

2.Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. 2023. https://www.cdc.gov/reprouctivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

3.World Health Organization. Trends in Maternal Mortality: 2000 to 2023. Geneva: WHO;2023. https://www.who.int/publications/i/item/9789240068759

4.Beasley JW, Dresang LT, Winslow DB, Damos JR. The Advanced Life Support in Obstetrics (ALSO) program: fourteen years of progress. Prehosp Disaster Med. 2005 Jul-Aug;20(4):271-5. Doi: 10.1017/s1049023x00002661. PMID: 16128478. 

5.California Maternal Quality Care Collaborative. Hemorrhage Risk Assessment & Checklist. 2025. https://www.cmqcc.org/

6.World Health Organization. Maternal and Perinatal Death Surveillance and Response: MPDSR Implementation Guide. Geneva: WHO;2021.

7.PeriGen. PeriGen Predictive Fetal Monitoring Software. 2025. https://www.perigen.com/

8.Collins, J., Cambiano, V., Phillips, A., & Colbourn, T. (2024). Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review. PLoS One, 19(12), e0296540.

9.United Nations. Sustainable Development Goals: Goal 3 – Ensure healthy lives and promote well-being for all at all ages. 2023. https://sdgs.un.org/goals/goal3