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. 2020 Jul;34(4):427-439.
doi: 10.1111/ppe.12574. Epub 2019 Aug 12.

Severe maternal morbidity surveillance: Monitoring pregnant women at high risk for prolonged hospitalisation and death

Susie Dzakpasu  1 , Paromita Deb-Rinker  1 , Laura Arbour  2 , Elizabeth K Darling  3 , Michael S Kramer  4 , Shiliang Liu  1 , Wei Luo  1 , Phil A Murphy  5 , Chantal Nelson  1 , Joel G Ray  6 , Heather Scott  7 , Michiel VandenHof  7 , K S Joseph  8
Affiliations

Severe maternal morbidity surveillance: Monitoring pregnant women at high risk for prolonged hospitalisation and death

Susie Dzakpasu et al. Paediatr Perinat Epidemiol. 2020 Jul.

Abstract

Background: There is no international consensus on the definition and components of severe maternal morbidity (SMM).

Objectives: To propose a comprehensive definition of SMM, to create an empirically justified list of SMM types and subtypes, and to use this to examine SMM in Canada.

Methods: Severe maternal morbidity was defined as a set of heterogeneous maternal conditions known to be associated with severe illness and with prolonged hospitalisation or high case fatality. Candidate SMM types/subtypes were evaluated using information on all hospital deliveries in Canada (excluding Quebec), 2006-2015. SMM rates for 2012-2016 were quantified as a composite and as SMM types/subtypes. Rate ratios and population attributable fractions (PAF) associated with overall and specific SMM types/subtypes were estimated in relation to length of hospital stay (LOS > 7 days) and case fatality.

Results: There were 22 799 cases of SMM subtypes (among 1 418 545 deliveries) that were associated with a prolonged LOS or high case fatality. Between 2012 and 2016, the composite SMM rate was 16.1 (95% confidence interval [CI] 15.9, 16.3) per 1000 deliveries. Severe pre-eclampsia and HELLP syndrome (514.6 per 100 000 deliveries), and severe postpartum haemorrhage (433.2 per 100 000 deliveries) were the most common SMM types, while case fatality rates among SMM subtypes were highest among women who had cardiac arrest and resuscitation (241.1 per 1000), hepatic failure (147.1 per 1000), dialysis (67.6 per 1000), and cerebrovascular accident/stroke (51.0 per 1000). The PAF for prolonged hospital stay related to SMM was 17.8% (95% CI 17.3, 18.3), while the PAF for maternal death associated with SMM was 88.0% (95% CI 74.6, 94.4).

Conclusions: The proposed definition of SMM and associated list of SMM subtypes could be used for standardised SMM surveillance, with rate ratios and PAFs associated with specific SMM types/subtypes serving to inform clinical practice and public health policy.

Keywords: maternal mortality; severe maternal morbidity; surveillance.

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References

    1. Loudon I. Maternal mortality in the past and its relevance to developing countries today. Am J Clin Nutr. 2000;72:241S‐S246. - PubMed
    1. Högberg U. The decline in maternal mortality in Sweden: the role of community midwifery. Am J Public Health. 2004;94:1312‐1320. - PMC - PubMed
    1. Joseph KS. Maternal mortality and serious maternal morbidity In: Louis GB, Platt RW, eds. Reproductive and perinatal epidemiology. Oxford University Press; 2011;204-221.
    1. Zhang WH, Alexander S, Bouvier‐Colle MH, Macfarlane A, MOMS‐B Group . Incidence of severe pre‐eclampsia, postpartum haemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population‐based study: the MOMS‐B survey. BJOG. 2005;112:89‐96. - PubMed
    1. Callaghan WM, Mackay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. Am J Obstet Gynecol. 2008;199(133):e1‐8. - PubMed

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