Constructing maternal morbidity – towards a standard tool to measure and monitor maternal health beyond mortality

Abstract

BackgroundMaternal morbidity is a complex entity and its presentation and severity are on a spectrum. This paper describes the conceptualization and development of a definition for maternal morbidity, and the framework for its measurement: the maternal morbidity matrix, which is the foundation for measuring maternal morbidity, thus, the assessment tool.DiscussionWe define maternal morbidity and associated disability as “any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman’s wellbeing and/or functioning.” A matrix of 121 conditions was generated through expert meetings, review of the International Classification of Diseases and related health problems (ICD-10), literature reviews, applying the definition of maternal morbidity and a cut-off of >0.1 % prevalence. This matrix has three dimensions: identified morbidity category, reported functioning impact and maternal history. The identification criteria for morbidity include 58 symptoms, 29 signs, 44 investigations and 35 management strategies; these criteria are aimed at recognizing the medical condition, or the functional impact/disability component that will capture the negative impact experienced by the woman.SummaryThe maternal morbidity matrix is a practical framework for assessing maternal morbidity beyond near-miss. In light of the emerging attention to Universal Health Coverage (UHC) as part of the post-2015 Sustainable Development Goals (SDGs) planning, a definition and standard identification criteria are essential to measuring its extent and impact.

A new conceptual framework for maternal morbidity

“…Despite the large numbers of estimated complications mentioned earlier, there is little comprehensive research on maternal morbidity. The range of conditions is so large that studies often focus on the most life‐threatening or debilitating causes of obstetric morbidity and/or on a single condition . The lack of comprehensiveness is not just in terms of conditions, but also in relation to the duration of observation.…”

“…As explained in the introduction, maternal morbidity first refers to “any health condition attributed to and/or complicating childbirth.” The categories used for the health conditions (bottom left, pink box) are from ICD‐MM and include obstetric morbidities, medical morbidities, and injuries . The first three categories include a total of 121 maternal morbidity conditions as reported within the maternal morbidity matrix mentioned earlier . It is worth noting that complications associated with surgical care and medical management, including cesarean delivery and episiotomy complications, are incorporated in obstetric conditions.…”

“…Age—being particularly young or particularly old—is also important, as well as parity . A list of past obstetric, medical, and social history conditions is included in Chou et al …”

“…A Maternal Morbidity Working Group (MMWG) was established to work on this challenging agenda and focused on understanding the entire experience of morbidity, including non‐life‐threatening conditions as well as more severe ones. The MMWG agreed on the following definition of maternal morbidity: “any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman's wellbeing and/or functioning” . This work led to a conceptual framework, entitled the Maternal Morbidity Measurement (MMM) Framework, externally reviewed, and displayed in Figure .…”

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

“…Pregnancy comorbidities such as GDM and hypertensive disorders of pregnancy not only have an immediate impact on maternal and neonatal health, but also bear short‐ and long‐term health consequences years and possibly decades after delivery, such as type 2 diabetes, CVD, and many other implications. In addition, and although not the scope of this Supplement, it also incurs long‐term impacts on the well‐being of the offspring and on maternal mental health, social conditions, quality of life, sexual satisfaction, and functioning/disability, among others …”