Severe maternal morbidity in Scotland

Abstract

Using a cohort study design, we analysed 17 diagnoses and 9 interventions (including critical care admission) as a composite measure of severe maternal morbidity for pregnancies recorded over 14 years in Scotland. There were 762,918 pregnancies, of which 7947 (10 in 1000 pregnancies) recorded 9345 severe maternal morbidity events, 2802 episodes of puerperal sepsis being the most common (30%). Severe maternal morbidity incidence increased from 9 in 1000 pregnancies in 2012 to 17 in 1000 pregnancies in 2018, due in part to puerperal sepsis recording. The odds ratio (95%CI) for severe maternal morbidity was higher for: older women, for instance 1.22 (1.13-1.33) for women aged 35-39 years and 1.44 (1.27-1.63) for women aged > 40 years compared with those aged 25-29 years; obese women, for instance 1.13 (1.06-1.21) for BMI 30-40 kg.m^-2 and 1.32 (1.15-1.51) for BMI > 40 kg.m^-2 compared with BMI 18.5-24.9 kg.m^-2 ; multiple pregnancy, 2.39 (2.09-2.74); and previous caesarean delivery, 1.52 (1.40-1.65). The median (IQR [range]) hospital stay was 3 (2-5 [1-8]) days with severe maternal morbidity and 2 (1-3 [1-5]) days without. Forty-one women died during pregnancy or up to 42 days after delivery, representing mortality rates per 100,000 pregnancies of about 365 with severe maternal morbidity and 1.6 without. There were 1449 women admitted to critical care, 807 (58%) for mechanical ventilation or support of at least two organs. We recorded an incidence of severe maternal morbidity higher than previously published, possibly because sepsis was coded inaccurately in our databases. Further research may determine the value of this composite measure of severe maternal morbidity.

Keywords: maternal critical care; risk factors; severe maternal morbidity.

Figure 1

Cohort flow diagram.

Figure 2

Pareto chart of the rates of 26 severe maternal morbidities per 1000 pregnancies, conditions (red) and procedures (blue). The black line is the cumulative proportion for all severe morbidities. DIC, disseminated intravascular coagulation. [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 3

(a–c) Odds ratios (95%CI) of characteristics associated with severe maternal mortality after model 1 multivariable adjustment. Reference categories have an odds ratio of 1. [Colour figure can be viewed at wileyonlinelibrary.com]