Severe acute maternal morbidity trends in Victoria, 2001–2017

Abstract

BackgroundThe incidence of severe acute maternal morbidity (SAMM) is one method of measuring the complexity of maternal health and monitoring maternal outcomes. Monitoring trends may provide a quantitative method for assessing health care at local, regional, or jurisdictional levels and identify issues for further investigation.AimsIdentify temporal trends for SAMM event rates and maternal outcomes over 17 years in the state of Victoria, Australia.Materials and MethodsAll maternal public health service admissions were extracted from an administrative dataset from July 2000 to June 2017. SAMM‐related diagnoses were defined by matching as closely as possible with published definitions. Outcomes included annual SAMM event rates, hospital survival, and hospital length of stay (LOS). Temporal trends were analysed using mixed‐effects generalised linear models.ResultsThere were 854 777 live births and 1.21 million pregnancy‐related hospital admissions which included 34 008 SAMM events in 29 273 records and in 3.42% (95%CI = 3.39–3.46) of births. Most common were severe pre‐eclampsia (0.87% of births), severe postpartum haemorrhage (0.59%), and sepsis (0.62%). SAMM‐related admissions were associated with longer LOS and higher mortality risk (P < 0.001). Maternal mortality ratio remained unchanged at 8.6 fatalities per 100 000 births (P = 0.65).ConclusionOver 17 years, there was a significant increase in birth rate and SAMM‐related events in Victoria. Administrative data may provide a pragmatic approach for monitoring SAMM‐related events in maternal health services.

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?

“…These studies assessed the level of severe morbidity either as a composite indicator or associated with a particular condition and/or to determine risk factors associated with severe morbidity using routinely collected datasets, with large sample sizes retrospectively correlated to ICD‐10 codes. Besides the MMOI, other ICD‐based criteria included the modified Wahlberg et al 22 criteria, a Centre for Disease Control (CDC) SMM tool 44 and a modified combination of the WHO plus American College of Obstetricians and Gynecologists diagnostic and intervention codes 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 40,41,43,46–51 …”

“…Besides the MMOI, other ICD-based criteria included the modified Wahlberg et al 22 criteria, a Centre for Disease Control (CDC) SMM tool 44 and a modified combination of the WHO plus American College of Obstetricians and Gynecologists diagnostic and intervention codes. 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]…”

Severe acute maternal morbidity reporting in Australia: Why is it so hard?

“…The literature describes various methods for investigating SAMM in Australia, including: prospective cross-sectional studies, 14 retrospective cohort studies collated using administrative and population health datasets, 14,15 and condition-specific registries. 16 A voluntary national reporting system, The Australasian Maternity Outcomes Surveillance System (AMOSS), was used to research selected rare and serious conditions in pregnancy 16 (details in Table 1).…”