Severe maternal morbidity: screening and review

Kilpatrick, Sarah; Ecker, Jeffrey L.

doi:10.1016/j.ajog.2016.07.050

Cited by 231 publications

(166 citation statements)

References 12 publications

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“…To ascertain the impact of SMM, robust and ascertainable data are required. The WHO [ 11 ] and the American College of Obstetricians and Gynecologists [ 61 ] recommend careful surveillance using real-time data, which are sometimes lacking, even in HICs. However, despite these recommendations, there remains uncertainty as to the optimum surrogate indicators for SMM.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

Mengistu

Turner

Flatley

et al. 2020

JCM

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While there is clear evidence that severe maternal morbidity (SMM) contributes significantly to poor maternal health outcomes, limited data exist on its impact on perinatal outcomes. We undertook a systematic review and meta-analysis to ascertain the association between SMM and adverse perinatal outcomes in high-income countries (HICs). We searched for full-text publications in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus databases. Studies that reported data on the association of SMM and adverse perinatal outcomes, either as a composite or individual outcome, were included. Two authors independently assessed study eligibility, extracted data, and performed quality assessment using the Newcastle–Ottawa Scale. We used random-effects modelling to calculate odds ratios (ORs) with 95% confidence intervals. We also assessed the risk of publication bias and statistical heterogeneity using funnel plots and Higgins I2, respectively. We defined sub-groups of SMM as hemorrhagic disorders, hypertensive disorders, cardiovascular disorders, hepatic disorders, renal disorders, and thromboembolic disorders. Adverse perinatal outcome was defined as preterm birth (before 37 weeks gestation), small for gestational age (SGA) (birth weight (BW) < 10th centile for gestation), low birthweight (LBW) (BW < 2.5 kg), Apgar score < 7 at 5 min, neonatal intensive care unit (NICU) admission, stillbirth and perinatal death (stillbirth and neonatal deaths up to 28 days). A total of 35 studies consisting of 38,909,426 women were included in the final analysis. SMMs associated with obstetric hemorrhage (OR 3.42, 95% CI: 2.55–4.58), severe hypertensive disorders (OR 6.79, 95% CI: 6.06–7.60), hepatic (OR 3.19, 95% CI: 2.46–4.13) and thromboembolic disorders (OR 2.40, 95% CI: 1.67–3.46) were significantly associated with preterm birth. SMMs from hypertensive disorders (OR 2.86, 95% CI: 2.51–3.25) or thromboembolic disorders (OR 1.48, 95% CI: 1.09–1.99) were associated with greater odds of having SGA infant. Women with severe hemorrhage had increased odds of LBW infant (OR 2.31, 95% CI: 1.57–3.40). SMMs from obstetric hemorrhage (OR 4.16, 95% CI: 2.54–6.81) or hypertensive disorders (OR 4.61, 95% CI: 1.17–18.20) were associated with an increased odds of low 5-min Apgar score and NICU admission (Severe obstetric hemorrhage: OR 3.34, 95% CI: 2.26–4.94 and hypertensive disorders: OR 3.63, 95% CI: 2.63–5.02, respectively). Overall, women with SMM were 4 times more likely to experience stillbirth (OR 3.98, 95% CI: 3.12–7.60) compared to those without SMM with cardiovascular disease (OR 15.2, 95% CI: 1.29–180.60) and thromboembolic disorders (OR 9.43, 95% CI: 4.38–20.29) conferring greatest risk of this complication. The odds of neonatal death were significantly higher in women with SMM (OR 3.98, 95% CI: 2.44–6.47), with those experiencing hemorrhagic (OR 7.33, 95% CI: 3.06–17.53) and hypertensive complications (OR 3.0, 95% CI: 1.78–5.07) at highest risk. Overall, SMM was also associated with higher odds of perinatal death (OR 4.74, 95% CI: 2.47–9.12) mainly driven by the increased risk in women experiencing severe obstetric hemorrhage (OR 6.18, 95% CI: 2.55–14.96). Our results highlight the importance of mitigating the impact of SMM not only to improve maternal health but also to ameliorate its consequences on perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

Mengistu

Turner

Flatley

et al. 2020

JCM

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“…15 There is no single definition of severe maternal morbidity, and hospital discharge data may make it difficult to differentiate variability within diagnoses that might constitute severe maternal morbidity. 16 Specifically, we used ICD-9-CM codes for each hospital discharge to identify the presence of any of 24 indicator conditions for severe maternal morbidity. We excluded blood transfusion from our definition of severe maternal morbidity because it is far more common than other morbidities and is collinear with other morbidities.…”

Section: Methodsmentioning

confidence: 99%

State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality

Jarlenski

Hutcheon

Bodnar

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the U.S. Methods We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer. Results The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, relative to those in states without such coverage (62.4 vs. 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% CI 4.0,16.5) of severe maternal morbidity in adjusted analyses, relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5,17.2) of severe maternal morbidity in adjusted analyses among private insurance-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively), nor for private-insurance paid hospitalizations (5.6 and 6.1 per 100,000, respectively). Conclusions State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary abortion and a reduced risk of severe maternal morbidity was observed in women covered by both Medicaid and private insurance. Results suggest that Medicaid coverage of medically necessary abortion is not harmful to maternal health.

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“…Some women die as a result of these complications, but a proportion of them narrowly escape death either by chance or due to the quality of care they receive [ 2 ]. Maternal deaths (MD) can be likened to the ‘tip of an iceberg’ with the base being maternal morbidity, in that more women survive pregnancy complications than the ones who die [ 3 , 4 ]. The primary indicator of maternal health care and hence quality of obstetric care is Maternal Mortality Ratio (MMR) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study

Chikadaya

Madziyire

Munjanja

2018

BMC Pregnancy Childbirth

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BackgroundMaternal ‘near miss’ can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care.MethodsA prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal ‘near miss’ at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal ‘near miss’ and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death.ResultsDuring this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal ‘near miss’ morbidity and 13 were maternal deaths. The maternal ‘near miss’ ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission.ConclusionThe MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.

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Severe maternal morbidity: screening and review

Cited by 231 publications

References 12 publications

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis

State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality

Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study

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