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

Susie Dzakpasu, Paromita Deb-Rinker, Laura Arbour, Elizabeth K Darling, Michael S Kramer, Shiliang Liu, Wei Luo, Phil A Murphy, Chantal Nelson, Joel G Ray, Heather Scott, Michiel VandenHof, K S Joseph, Susie Dzakpasu, Paromita Deb-Rinker, Laura Arbour, Elizabeth K Darling, Michael S Kramer, Shiliang Liu, Wei Luo, Phil A Murphy, Chantal Nelson, Joel G Ray, Heather Scott, Michiel VandenHof, K S Joseph

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.

© 2019 The Authors. Paediatric and Perinatal Epidemiology Published by John Wiley & Sons Ltd.

References

    1. Loudon I. Maternal mortality in the past and its relevance to developing countries today. Am J Clin Nutr. 2000;72:241S‐S246.
    1. Högberg U. The decline in maternal mortality in Sweden: the role of community midwifery. Am J Public Health. 2004;94:1312‐1320.
    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.
    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.
    1. Roberts CL, Ford JB, Algert CS, Bell JC, Simpson JM, Morris JM. Trends in adverse maternal outcomes during childbirth: a population‐based study of severe maternal morbidity. BMC Pregnancy Childbirth. 2009;9:7.
    1. Liu S, Joseph KS, Bartholomew S, Fahey J, Lee L, Allen A. et al.; for the Maternal Health Study Group of the Canadian Perinatal Surveillance . Temporal trends and regional variations in severe maternal morbidity in Canada, 2003 to 2007. J Obstet Gynaecol Can 2010;32:847‐855.
    1. Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health. 2018;15(Suppl 1):98.
    1. Canadian Perinatal Health Report , 2008 Edition Public Health Agency of Canada. Ottawa: Minister of Public Works and Government Services Canada, 2008.
    1. Fell DB, Joseph KS, Dodds L, Allen AC, Jangaard K, Van den Hof M. Trends in maternal characteristics in Nova Scotia, Canada from 1988 to 2001. Can J Public Health. 2005;96:234‐238.
    1. Lawton B, MacDonald EJ, Brown SA, et al. Preventability of severe acute maternal morbidity. Am J Obs Gynecol. 2014;210(557):e1‐6.
    1. Van Dillen J, Mesman J, Zwart JJ, Bloemenkamp KW, van Roosmalen J. Introducing maternal morbidity audit in the Netherlands. BJOG. 2010;117:416‐421.
    1. Della Torre M, Kilpatrick SS, Hibbard JJ, et al. Assessing preventability for obstetric hemorrhage. Am J Perinatol. 2011;28:753‐760.
    1. Kominiarek MA, Scott S, Koch AR, et al. Preventing maternal morbidity from obstetric hemorrhage: implications of a provider training initiative. Am J Perinatol. 2017;34:74‐79.
    1. Say L, Pattinson RC. Gülmezoglua M. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1:3.
    1. Evaluating the quality of care for severe pregnancy complications . The WHO near‐miss approach for maternal health. Geneva: World Health Organization; 2011. ().
    1. Wen SW. Severe maternal morbidity ratio. In: Canadian Perinatal Health Report, 2003. Ottawa: Minister of Public Works and Government Services Canada, 2003. ().
    1. Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, et al; Maternal Health Study Group , Canadian Perinatal Surveillance System . Severe maternal morbidity in Canada, 1991–2001. CMAJ. 2005;173:759‐764.
    1. Joseph KS, Liu S, Rouleau J, Kirby RS, Kramer MS, Sauve R, for the Maternal Health Study Group of the Canadian Perinatal Surveillance System . Severe maternal morbidity in Canada, 2003 to 2007: Surveillance using routine hospitalization data and ICD‐10CA codes. J Obstet Gynaecol Can. 2003;2010(32):837‐846.
    1. Wen SW, Liu S, Marcoux S, Fowler D. Uses and limitations of routine hospital admission/separation records for perinatal surveillance. Chronic Dis Can. 1997;18:113‐119.
    1. Joseph KS, Fahey J. Validation of perinatal data in the Discharge Abstract Database of the Canadian Institute for Health Information. Chronic Dis Can. 2009;29:96‐100.
    1. Frosst G, Hutcheon J, Joseph KS, Kinniburgh B, Johnson C, Lee L. Validating the British Columbia Perinatal Data Registry: a chart re‐abstraction study. BMC Pregnancy Childbirth. 2015;15:123.
    1. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88:15‐19.
    1. Bouvier‐Colle M‐H, Mohangoo AD, Gissler M, et al. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. BJOG. 2012;119:880‐890.
    1. Nair M, Kurinczuk JJ, Knight M. Establishing a national maternal morbidity outcome indicator in England: a population‐ based study using routine hospital data. PLoS ONE. 2016;11:1‐17.
    1. Deneux‐Tharaux C, Bouvier‐Colle M‐H, EPIMOMS Study Group . Severe acute maternal morbidity in France: the epimoms population‐based study. Am J Obstet Gynecol. 2017;216:S345‐S346.
    1. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120:1029‐1036.
    1. Say L, Souza JP, Pattinson RC. WHO working group on Maternal Mortality and Morbidity classifications . Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23:287‐296.
    1. Pattinson R, Say L, Souza JP, et al. WHO maternal death and near‐miss classifications. Bull World Health Organ. 2009;87:734.
    1. Witteveen T, de Koning I, Bezstarosti H, van den Akker T, van Roosmalen J, Bloemenkamp KW. Validating the WHO Maternal Near Miss Tool in a high‐income country. Acta Obstet Gynecol Scand. 2016;95:106‐111.
    1. Witteveen T, Bezstarosti H, de Koning I, et al. Validating the WHO maternal near miss tool: comparing high‐ and low‐resource settings. BMC Pregnancy Childbirth. 2017;17:194.
    1. Roberts CL, Cameron CA, Bell JC, Algert CS, Morris JM. Measuring maternal morbidity in routinely collected health data: development and validation of a maternal morbidity outcome indicator. Med Care. 2008;46:786‐794.
    1. Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population‐based study to inform prepregnancy weight loss counseling. Obstet Gynecol. 2015;125:133‐143.
    1. Ray JG, Urquia ML, Berger H, Vermeulen MJ. Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units. CMAJ. 2012;184:E956‐E962.

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