Trend and risk Factors for Severe Peripartum Maternal morbidity - a population-based Cohort Study.
Objectives: While the rates of maternal mortality in developed countries have remained low in recent years, rates of severe maternal morbidity (SMM) are still increasing in high income countries. As a result, SMM is currently used as a measure of maternity care level. The aim of this study was to in...
| Published in: | Maternal & Child Health Journal Vol. 27; no. 4; pp. 719 - 728 |
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| Main Authors: | , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Springer Nature
Apr2023
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=162508344&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 162508344 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10927875 N9J jtl: Maternal & Child Health Journal issn: 10927875 maglogo: N pubinfo: dt: Apr2023 vid: 27 iid: 4 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 162508344 161392039 162508344 162508344 10.1007/s10995-022-03568-2 162508344 ppf: 719 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Trend and risk Factors for Severe Peripartum Maternal morbidity - a population-based Cohort Study. aug: au: Ben-Ayoun, Danielle Walfisch, Asnat Wainstock, Tamar Sheiner, Eyal Imterat, Majdi affil: Faculty of Health Sciences, Ben-Gurion University of the Negev, 151 Izak Rager Ave. Beer-Sheva, 84101, Beer-Sheva, Israel sug: subj: Pregnancy Complications Trends Pregnancy Complications Risk Factors Risk Assessment Morbidity Risk Factors Morbidity Trends Human Prospective Studies Case Control Studies Intensive Care Units Comparative Studies Multiple Logistic Regression Placenta Praevia Childbirth, Premature Placenta Accreta Parity Jews Abortion, Spontaneous Israel Pregnancy Female Descriptive Statistics Data Analysis Software Fisher's Exact Test Pearson's Correlation Coefficient Paired T-Tests Mann-Whitney U Test Female ab: Objectives: While the rates of maternal mortality in developed countries have remained low in recent years, rates of severe maternal morbidity (SMM) are still increasing in high income countries. As a result, SMM is currently used as a measure of maternity care level. The aim of this study was to investigate the prevalence and risk factors of SMM surrounding childbirth. Methods: A nested case-control study was performed between the years 2013–2018. SMM was defined as peripartum hospitalization involving intensive care unit (ICU). A comparison was conducted between parturient with SMM to those without, randomly matched for delivery mode and date of birth in a 1:1 ratio. Multivariable logistic regression models were used to evaluate the independent association between SMM and different maternal and pregnancy characteristics. Results: During the study period, 96,017 live births took place, of which 144 (1.5 per 1,000 live births-0.15%) involved SMM with ICU admissions. Parturient with SMM were more likely to have a history of 2 or more pregnancy losses (18.2% vs. 8.3%, p = 0.004), deliver preterm (48.9% vs. 8.8%, p < 0.001), and suffer from placenta previa (11.9% vs. 1.5%, p < 0.001), and/or placenta accreta (9.7% vs. 1.5%, p = 0.003). Several significant and independent risk factors for SMM were noted in the multivariable regression models: preterm delivery, history of ≥ 2 pregnancy losses, grand-multiparity, Jewish ethnicity, and abnormal placentation (previa or accreta). Conclusions for Practice: SMM rates in our cohort were lower than reported in developed countries. An independent association exists between peripartum maternal ICU admissions and several demographic and clinical risk factors, including preterm birth and abnormal placentation. Significance: What is Already Known on this Subject?: Severe maternal morbidity (SMM) is a key measure of maternity care quality. In recent years, as maternal mortality rates decline significantly in developed countries and due to its higher incidence, SMM has been suggested as a surrogate for quality assessment of maternity care evaluation. What this Study adds?: SMM rate appear to decrease during the study period, from 1.56 to 2013 to 1.12 per 1,000 in 2018. An independent association exists between peripartum maternal ICU admissions and several demographic and clinical risk factors: abnormal placentation (placenta previa or placenta accreta), preterm delivery (< 37 weeks), grand multiparity (≥ 5), history of recurrent pregnancy loss, and Jewish ethnicity (as opposed to Bedouin). These associations were independent of each other and additionally adjusted for several clinically relevant confounders. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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