Transforming Obstetric Care Through an MFM-Led Architectural System: A Proposed Model for High-Value Care Running Title: Transforming Obstetric Care: MFM architecture

Objective: To describe a maternal–fetal medicine (MFM)–led, protocolized, integrated care model in which subspecialists serve as system-level clinical governors, and to present associated outcomes relative to regional, national, and published benchmarks and existing maternity care models. Study Design: We conducted a single-system descriptive analysis of a moderately sized, integrated, MFM-led women's health organization with more than 3,500 annual deliveries during 2024–2025. Outcomes were evaluated across five domains: preterm birth (PTB) prevention, low-risk cesarean reduction, diabetes management, maternal opioid use disorder (OUD), and low-dose aspirin (LDASA) use for preeclampsia prevention. Performance was compared with Clark County, Nevada, national, and literature-based benchmarks, and the organizational structure with existing maternity care models. Results: The PTB rate was 10.0%, compared with 11.4% in Clark County. The nulliparous, term, singleton, vertex cesarean rate was 24.6%, compared with 28.5% in Clark County; the SMFM cesarean rate was 12.0%, compared with 16.7% in Nevada. Self-monitored blood glucose adherence was 96%, versus 68% nationally. Pharmacologic treatment for neonatal opioid withdrawal syndrome was 11.1%, versus published rates of 50%–85%. LDASA self-reported use reached 95% among eligible patients. Applying published per-case costs, estimated annual savings from PTB prevention and low-risk cesarean reduction were $4.03 million. Unlike other models, this architecture places MFMs in system-level governance roles, designing and disseminating protocols across all obstetric provider types while integrating high- and low-risk care. Conclusion: This community-based model operationalizes the SMFM call for a transformed maternity care team by combining subspecialist governance with multi-domain protocol implementation. It is designed to identify and treat at-risk patients before progression to high-risk status and adverse outcomes.