Examining adverse fetal/neonatal outcomes associated with severe maternal morbidity

Abstract

Background: While there is a global focus on severe maternal morbidity (SMM), less is known about the impact of SMM on fetal and neonatal outcomes. Aims: To examine fetal/neonatal outcomes associated with SMM. Materials and Methods: A national New Zealand (NZ) retrospective cohort study describing fetal/neonatal outcomes of all women with SMM admitted to a NZ Intensive Care Unit (ICU) or High Dependency Unit (HDU) in 2014. Adverse fetal/ neonatal outcomes were defined as one or more of the following: fetal or early neonatal death, hypoxic ischaemic encephalopathy, Apgar score less than seven at five minutes, admission to Neonatal Intensive Care Unit or Special Care Baby Unit. Results: There were 400 women with SMM admitted to NZ ICU/HDU units in 2014, and 395 (98.8%) had complete birth/pregnancy outcome information. Of these, 49.4% (195/395) were associated with an adverse fetal/neonatal outcome. Indigenous Māori women had a 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women (63.7% and 48.9% respectively; relative risk = 1.30, 95% CI 1.04-1.64). Pre-eclampsia was associated with an adverse fetal/ neonatal outcome in 67% (81/120). Perinatal-related mortality rate was 53.1 per 1000 total births compared to NZ perinatal mortality of 11.2 per 1000 total births for 2014. Conclusion: SMM events are associated with high rates of adverse fetal/neonatal outcomes with a higher burden of adverse events for Māori. Further research is needed to explore opportunities in maternal and neonatal care pathways to improve fetal/neonatal outcomes and address inequities. K E Y W O R D S ethnic disparities, fetal/neonatal outcomes, severe maternal morbidity BACKGROUND Globally, it is estimated that severe maternal morbidity (SMM) occurs in approximately 1-2% of pregnancies with a greater incidence in minority populations. 1-4 It is estimated that approximately 30-40% of these severe events are potentially preventable. 5-7 SMM or maternal near-miss are terms used to identify women with life-threatening complications in pregnancy. The World Health Organization (WHO) defines this severe end of the morbidity spectrum as 'the near death of a woman who has survived a

Examining the potential preventability of adverse fetal/neonatal outcomes associated with severe maternal morbidity

“…8 Māori women had an almost 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women. 8 However, little is known about the preventability of these adverse outcomes.…”

“…[5][6][7] While the focus has concentrated on maternal outcomes, there is increasing interest in the impact of SMM on delivery outcomes and neonatal wellbeing. 2,6,8 In a recent New Zealand (NZ) study, almost half of all SMM cases had an adverse fetal/neonatal outcome. Delivery at less than 32 weeks gestation was ten times more likely than in the general birthing population.…”

“…Delivery at less than 32 weeks gestation was ten times more likely than in the general birthing population. 8 Of those women delivering at term, nearly a quarter had an adverse fetal/neonatal outcome. 8 Māori women had an almost 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women.…”

“…8 Of those women delivering at term, nearly a quarter had an adverse fetal/neonatal outcome. 8 Māori women had an almost 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women. 8 However, little is known about the preventability of these adverse outcomes.…”

A scoping review of maternal near miss assessment in Australia, New Zealand, South‐East Asia and the South Pacific region: How, what, why and where to?

“…45 ICU admissions are also relatively easily attained and most of these studies, undertaken in NZ, were used to assess the potentially modifiable factors in the management of SMM. 40,41,43,[46][47][48][49][50][51]…”