Severe maternal morbidity in Scotland

Abstract

Summary 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.

Long-term effects of neuraxial analgesia

“…Severe maternal morbidity (SMM) is a potentially life-threatening outcome of pregnancy, is increasing in incidence, and is strongly associated with maternal mortality [33]. Risk factors for SMM include older maternal age, higher BMI, comorbidities, previous caesarean and multiple births, none of which are easily modifiable [34]. A New York populationbased cohort study found a reduction in risk of SMM in women who received epidural analgesia in labour, with these associations strongest in women with preexisting comorbidities [1 but may include altered physiological stress response, the use of the epidural to provide rapid anaesthesia for operative delivery (with avoidance of other anaesthetic modalities), as well as enhanced monitoring and increased anaesthetic oversight.…”

Current perspectives on maternity critical care

“…Of 762,918 pregnancies, 1% of women experienced one or more severe maternal morbidity events, with obstetric sepsis being the most common. Notably, severe maternal morbidity increased from 9/1000 pregnancies in 2012, to 17/1000 pregnancies in 2018 [17].…”

Severe maternal morbidity surveillance, temporal trends and regional variation: A population‐based cohort study

“…The SMM rate has doubled in the USA from 1993 to 2014, 11 whereas in Canada there has been an annual increase of 1.3% from 2004 to 2015 13 . Similarly, Ireland has recorded a rise of 68% in the SMM rate in 2019, compared with 2011, 14 and in Scotland the incidence rose from nine to 17 per 1000 deliveries from 2012 to 2018 15 . Unfortunately, between‐country comparisons of SMM rates are not simple because of the large discrepancies in the reported component types and subtypes of SMM 16,17 …”

“…13 Similarly, Ireland has recorded a rise of 68% in the SMM rate in 2019, compared with 2011, 14 and in Scotland the incidence rose from nine to 17 per 1000 deliveries from 2012 to 2018. 15 Unfortunately, between-country comparisons of SMM rates are not simple because of the large discrepancies in the reported component types and subtypes of SMM. 16,17 In Sweden, there is a dearth of information on temporal trends and regional differences in SMM.…”