Population-Based Study of Risk Factors for Severe Maternal Morbidity (original) (raw)

Opportunities for improvement in care among women with severe maternal morbidity

American journal of obstetrics and gynecology, 2016

Severe maternal morbidity is increasing in the United States and has been estimated to occur in up to 1.3% of all deliveries. A standardized, multidisciplinary approach has been recommended to identify and review cases of severe maternal morbidity to identify opportunities for improvement in maternal care. The aims of our study were to apply newly described gold standard guidelines to identify true severe maternal morbidity and to utilize a recently recommended multidisciplinary approach to determine the incidence of and characterize opportunities for improvement in care. We conducted a retrospective cohort study of all women admitted for delivery at Cedars-Sinai Medical Center from Jan. 1, 2012, through June 30, 2014. Electronic medical records were screened for severe maternal morbidity using the following criteria: International Classification of Diseases, Ninth Revision codes for severe illness identified by the Centers for Disease Control and Prevention; prolonged length of sta...

Frequency of and Factors Associated With Severe Maternal Morbidity

Obstetrics & Gynecology, 2014

Objective-To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence. Methods-This was a secondary analysis of a National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (> 3 units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity, these were used to develop a prediction model for severe maternal morbidity.

The continuum of maternal morbidity and mortality: Factors associated with severity

American Journal of Obstetrics and Gynecology, 2004

Objective: The goal of this study was to examine whether sociodemographic, clinical, and other service-related factors, as well as preventability issues affect a woman's progression along the continuum of morbidity and mortality. Study design: This was a case-control study of pregnancy-related deaths, women with near-miss morbidity, and those with other severe, but not life threatening, morbidity. Factors associated with maternal outcome were examined. Results: Provider factors (related to preventability) and clinical diagnosis were significantly associated with progression along the continuum after controlling for sociodemographic characteristics (P ! .01 for both associations). Conclusion: In order to improve mortality rates, we must understand maternal morbidity and how it may lead to death. This study shows that important initiatives include addressing preventability, in particular, provider factors, which may play a role in moving women along the continuum of morbidity and mortality.

Severe Maternal Morbidity, A Tale of 2 States Using Data for Action—Ohio and Massachusetts

Maternal and Child Health Journal, 2019

Purpose-Describe how Ohio and Massachusetts explored severe maternal morbidity (SMM) data, and used these data for increasing awareness and driving practice changes to reduce maternal morbidity and mortality. Description-For 2008-2013, Ohio used de-identified hospital discharge records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify delivery hospitalizations. Massachusetts used existing linked data system infrastructure to identify delivery hospitalizations from birth certificates linked to hospital discharge records. To identify delivery hospitalizations complicated by one or more of 25 SMMs, both states applied an algorithm of ICD-9-CM diagnosis and procedure codes. Ohio calculated a 2013 SMM rate of 144 per 10,000 delivery hospitalizations; Massachusetts calculated a rate of 162. Ohio observed no increase in the SMM rate from 2008 to 2013; Massachusetts observed a 33% increase. Both identified disparities in SMM rates by maternal race, age, and insurance type. Assessment-Ohio and Massachusetts engaged stakeholders, including perinatal quality collaboratives and maternal mortality review committees, to share results and raise awareness about the SMM rates and identified high-risk populations. Both states are applying findings to Elizabeth J.

Incidence and Predictors of Severe Obstetric Morbidity: Case-Control Study

Obstetrical & Gynecological Survey, 2002

Objective To estimate the incidence and predictors of severe obstetric morbidity. Design Development of definitions of severe obstetric morbidity by literature review. Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case. Setting All 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998. Participants 48 865 women who delivered during the time frame. Results There were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment. Conclusion Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.

Severe Obstetric Morbidity in the United States: 1998–2005

Obstetrics & Gynecology, 2009

Objective-To examine trends in the rates of severe obstetric complications and the potential contribution of changes in delivery mode and maternal characteristics to these trends. Methods-We performed a cross-sectional study of severe obstetric complications identified from the 1998-2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Logistic regression was used to examine the effect of changes in delivery mode and maternal characteristics on rates of severe obstetric complications. Results-The prevalence of delivery hospitalizations complicated by at least of one severe obstetric complications increased from 0.64% (n=48,645) in 1998-99 to 0.81% (n=68,433) in 2004-05. Rates of complications per 1,000 which increased significantly during the study period included renal failure by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57). In logistic regression models, adjustment for maternal age had no effect on the increased risk for these complications in 2004-05 relative to 1998-99. However, after adjustment for mode of delivery, the increased risks for these complications in 2004-05 relative to 1998-99 were no longer significant, with the exception of pulmonary embolism (OR=1.30) and blood transfusion (OR=1.72). Further adjustment for payer, multiple births, and select comorbidites had little effect. Conclusions-Rates of severe obstetric complications increased from 1998-99 to 2004-05. For many of these complications, these increases were associated with the increasing rate of cesarean delivery.

Associations Between Comorbidities and Severe Maternal Morbidity

Obstetric Anesthesia Digest, 2021

Objective: To evaluate the associations between the number of chronic conditions and maternal race and ethnicity ("race") with the risk of severe maternal morbidity. Methods: Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016-2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression. Results: The rate of severe maternal morbidity was 139.7 per 10,000 deliveries. Compared to women with no comorbidities (rate=48.5 per 10,000), there was increased risk of severe maternal morbidity among women with one comorbidity (rate=238.6; OR=5.0 [95% CI: 4.8-5.2]), two comorbidities (rate=379.9; OR=8.1 [95% CI: 7.8-8.5]), or three or more comorbidities (rate=560; OR=12.1 [95% CI: 11.5-12.7]). In multivariable regressions, similar associations were noted for women with one (aOR=4.4 [95% CI: 4.2-4.6]), two (aOR=6.6 [95% CI: 6.3-6.9]), or three or more comorbidities (aOR=9.1 [95% CI: 8.7-9.6]). Black women had higher rates of comorbid conditions than all other racial and ethnic groups, with 55% (95% CI: 54%-56%) of black women having no comorbidities, compared to 67% (95% CI: 67%-68%) of white women, 68% (95% CI: 67%-69%) of Hispanic women, and 72% (95% CI: 71%-73%) of Asian women. Conclusions: We found a dose-response relationship between number of comorbidities and risk of severe maternal morbidity, with the highest rates of severe maternal morbidity among women with three or more comorbidities. Focusing on the prevention and treatment of chronic conditions