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Domingues RMSM, Meijinhos LDS, Guillen LCT, Dias MAB, Saraceni V, Pinheiro RS, Paiva NS, Coeli CM. Validation study of obstetric hospitalization data held on the Brazilian National Health System Hospital Information System for maternal morbidity surveillance: Brazil, 2021-2022. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2024; 33:e20231252. [PMID: 39082584 PMCID: PMC11295267 DOI: 10.1590/s2237-96222024v33e20231252.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/14/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE To validate the Brazilian National Health System Hospital Information System (SIH/SUS) for maternal morbidity surveillance. METHODS This was a cross-sectional study conducted in 2021/2022, taking as its reference a national study on maternal morbidity (MMG) conducted in 50 public and 28 private hospitals; we compared SIH/SUS and MMG data for hospitalization frequency, reason and type of discharge and calculated sensitivity, specificity, positive and negative likelihood ratios for seven diagnoses and four procedures. RESULTS Hospitalizations identified on SIH/SUS (32,212) corresponded to 95.1% of hospitalizations assessed by MMG (33,867), with lower recording on SIH/SUS (85.5%) for private hospitals [10,036 (SIH/SUS)]; 11,742 (MMG)]; compared to MMG, SIH/SUS had a lower proportion of hospitalizations due to "complications during pregnancy" (9.7% versus 16.5%) as well as under-recording of all diagnoses and procedures assessed, except "ectopic pregnancy". CONCLUSION Better recording of diagnoses and procedures on SIH/SUS is essential for its use in maternal morbidity surveillance.
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Affiliation(s)
| | - Lana dos Santos Meijinhos
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Luis Carlos Torres Guillen
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Marcos Augusto Bastos Dias
- Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente “Fernandes Figueira”, Rio de Janeiro, RJ, Brazil
| | - Valéria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Superintendência de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrinho Pinheiro
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Natália Santana Paiva
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Cláudia Medina Coeli
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro, RJ, Brazil
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Dzakpasu S, Nelson C, Darling EK, Edwards W, Murphy PA, Scott H, Van den Hof M, Ray JG. Trends in rate of hypertensive disorders of pregnancy and associated morbidities in Canada: a population-based study (2012-2021). CMAJ 2024; 196:E897-E904. [PMID: 39074863 PMCID: PMC11286177 DOI: 10.1503/cmaj.231547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are a leading cause of severe maternal morbidity (SMM). We sought to explore trends in HDP and related morbidity outcomes in Canada. METHODS In this retrospective population-based study, we used hospital discharge data from Canada, excluding Quebec, to identify females who had an HDP diagnosis during a birth admission between 2012 and 2021. We analyzed temporal and geographical trends in HDP, as well as temporal trends in adverse outcomes associated with HDP. RESULTS Among 2 804 473 hospital admissions for birth between 2012 and 2021, the rate of any HDP increased from 6.1% to 8.5%, including pre-existing hypertension (0.6% to 0.9%), gestational hypertension (3.9% to 5.1%), and preeclampsia (1.6% to 2.6%). For 2017-2021 combined, relative to Ontario (6.9%), HDP were significantly more prevalent in nearly all other Canadian regions. For example, in Newfoundland and Labrador, the rate was 10.7% (unadjusted rate ratio 1.56, 95% confidence interval 1.49-1.63). Among females with any HDP, rates of cesarean delivery rose from 42.0% in 2012 to 44.3% in 2021, as did acute renal failure (0.4% to 0.6%), while rates of early preterm delivery, intrauterine fetal death, maternal hospital length of stay (≥ 7 d), admission to the maternal intensive care unit, severe hemorrhage, and SMM trended downward. INTERPRETATION The rate of HDP has risen across Canada, with a concomitant decline in some HDP-associated morbidities. Ongoing surveillance of HDP is needed to assess the factors associated with temporal trends, including the effectiveness of evolving HDP prevention and management efforts.
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Affiliation(s)
- Susie Dzakpasu
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont.
| | - Chantal Nelson
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
| | - Elizabeth K Darling
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
| | - Wesley Edwards
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
| | - Phil A Murphy
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
| | - Heather Scott
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
| | - Michiel Van den Hof
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
| | - Joel G Ray
- Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont
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Wei SQ, Luu TM, Ayoub A, Lewin A, Auger N. Assisted Reproductive Technology During COVID-19: A Population-Based Study Of Pregnancy Outcomes. Reprod Sci 2024:10.1007/s43032-024-01649-x. [PMID: 39030447 DOI: 10.1007/s43032-024-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
We assessed the impact of the COVID-19 pandemic on the pregnancy outcomes of patients who used assisted reproductive technology. We conducted a population-based cohort study of 443,101 patients who conceived naturally or with assisted reproductive technology between December 2015 and July 2021 and had a delivery in hospitals of Quebec, Canada. The main exposure measure was use of assisted reproductive technology before or during the pandemic. Outcomes included preeclampsia, preterm birth, and other pregnancy complications. We used adjusted log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association of assisted reproductive technology with adverse pregnancy outcomes compared with natural conception before vs. during the pandemic. In secondary analyses, we examined the association of COVID-19 infection with pregnancy outcomes among women who used assisted reproductive technology. Compared with natural conception, assisted reproductive technology was associated with an increased risk of preeclampsia (RR 1.43; 95% CI 1.21-1.68), preterm birth (RR 2.07; 95% CI 1.84-2.33), and low birth weight (RR 1.94; 95% CI 1.72-2.20) during the pandemic. However, the same risks were also present before the pandemic. Compared with no infection, COVID-19 infection was not associated with adverse outcomes among women who conceived with assisted reproductive technology. This study suggests that the COVID-19 pandemic did not significantly impact the pregnancy outcomes of women who underwent assisted reproductive procedures in Quebec. The findings are reassuring for patients concerned about the potential reproductive effects of the pandemic.
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Affiliation(s)
- Shu Qin Wei
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, QC, Canada
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Antoine Lewin
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
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Bian Y, Zheng S, Liu X, Jiang X. Prediction model for severe maternal morbidity in pregnant women with hypertensive disorders of pregnancy. Pak J Med Sci 2024; 40:1054-1062. [PMID: 38952510 PMCID: PMC11190401 DOI: 10.12669/pjms.40.6.9095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/10/2023] [Accepted: 03/18/2024] [Indexed: 07/03/2024] Open
Abstract
Objectives To investigate risk factors for severe maternal morbidity (SMM) in pregnant women with hypertensive disorders of pregnancy (HDP) and to develop a risk prediction model. Methods A prospective observational cohort study was conducted among pregnant women who were hospitalized for hypertensive disorders of pregnancy (HDP) between January 2016 and December 2020 in Fujian College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Province, China (a training set), and a risk predictive model was constructed. Pregnant women with HDP who were hospitalized between January 2021 and December 2021 were selected as a validation set. Concordance index (C-index) and calibration curves were used to test predictive model discrimination and calibration. Results We included 970 pregnant women (790 in the training set and 180 in the validation set). Least absolute shrinkage and selection operator regression was used to screen for nine related variables such as intra-uterine growth retardation (IUGR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) at suspected diagnosis, total bilirubin, albumin (ALB), uric acid, total cholesterol, serum magnesium, and suspected gestational age. SBP at suspected diagnosis (OR =1.22, 95%CI:1.08-1.42) and total cholesterol (OR = 1.78, 95%CI:1.17-2.80) were independent risk factors of severe maternal morbidity in pregnant women with HDP. A nomogram was constructed, and internal validation of the nomogram model was done using the bootstrap self-sampling method. C-index in the training and the validation set was 0.798 and 0.909, respectively. Conclusion Our prediction model can be used to determine gestational hypertension severity in pregnant women.
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Affiliation(s)
- Yan Bian
- Yan Bian, Labour Ward, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
| | - Shuisen Zheng
- Shuisen Zheng, Department of of Obstetrics Resident Physician. Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
| | - Xiuwu Liu
- Xiuwu Liu, Department of Nursing, Labour Ward, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
| | - Xiuming Jiang
- Xiuming Jiang, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University,Fuzhou City, Fujian Province, China
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Zerbo A, Kang-Auger S, Jutras G, Brousseau É, Healy-Profitós J, Auger N. Hyperemesis gravidarum and risk of severe maternal morbidity: a retrospective cohort study. Am J Obstet Gynecol MFM 2024; 6:101392. [PMID: 38821181 DOI: 10.1016/j.ajogmf.2024.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Aïsha Zerbo
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Sarit Kang-Auger
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Gabrielle Jutras
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Émilie Brousseau
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Gerede A, Nikolettos K, Vavoulidis E, Margioula-Siarkou C, Petousis S, Giourga M, Fotinopoulos P, Salagianni M, Stavros S, Dinas K, Nikolettos N, Domali E. Vaginal Microbiome and Pregnancy Complications: A Review. J Clin Med 2024; 13:3875. [PMID: 38999442 PMCID: PMC11242209 DOI: 10.3390/jcm13133875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/12/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: There are indications that the microbial composition of the maternal mucosal surfaces is associated with adverse events during pregnancy. The aim of this review is to investigate the link between vaginal microbiome alterations and gestational complication risk. Methods: This comprehensive literature review was performed using Medline and Scopus databases. The following search algorithm was used, "Pregnancy Complications" [Mesh] AND (Vagin*), and after the literature screening, 44 studies were included in the final review. Results: The studies that were included investigated the association between vaginal microbial composition and preterm birth, miscarriage, preeclampsia, ectopic pregnancy, gestational diabetes mellitus, chorioamnionitis, and preterm premature rupture of membranes. In most of the studies, it was well established that increased microbial diversity is associated with these conditions. Also, the depletion of Lactobacillus species is linked to most of the gestational complications, while the increased relative abundance and especially Lactobacillus crispatus may exert a protective effect in favor of the pregnant woman. Several pathogenic taxa including Gardnerella, Prevotella, Sneathia, Bacterial Vaginosis-Associated Bacteria-2, Atopobium, and Megasphera seem to be correlated to higher maternal morbidity. Conclusions: Vaginal microbiome aberrations seem to have an association with pregnancy-related adverse events, but more high-quality homogenous studies are necessary to reliably verify this link.
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Affiliation(s)
- Angeliki Gerede
- Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece
| | - Konstantinos Nikolettos
- Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece
| | - Eleftherios Vavoulidis
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54640 Thessaloniki, Greece
| | - Chrysoula Margioula-Siarkou
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54640 Thessaloniki, Greece
| | - Stamatios Petousis
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54640 Thessaloniki, Greece
| | - Maria Giourga
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece
| | - Panagiotis Fotinopoulos
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece
| | - Maria Salagianni
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece
| | - Sofoklis Stavros
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54640 Thessaloniki, Greece
| | - Nikolaos Nikolettos
- Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece
| | - Ekaterini Domali
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece
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Ukah UV, Côté-Corriveau G, Nelson C, Healy-Profitós J, Auger N. Risk of Adverse Neonatal Events in Pregnancies Complicated by Severe Maternal Morbidity. J Pediatr 2024; 273:114149. [PMID: 38880382 DOI: 10.1016/j.jpeds.2024.114149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the risk of adverse neonatal events after a pregnancy complicated by severe maternal morbidity. STUDY DESIGN We analyzed a population-based cohort of deliveries in Quebec, Canada, between 2006 and 2021. The main exposure measure was severe maternal morbidity, comprising life-threatening conditions such as severe hemorrhage, cardiac complications, and eclampsia. The outcome included adverse neonatal events such as very preterm birth (gestational age <32 weeks), bronchopulmonary dysplasia, hypoxic ischemic encephalopathy, and neonatal death. Using log-binomial regression models, we estimated adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the association between severe maternal morbidity and adverse neonatal events. RESULTS Among 1 199 112 deliveries, 29 992 (2.5%) were complicated by severe maternal morbidity and 83 367 (7.0%) had adverse neonatal events. Severe maternal morbidity was associated with 2.96 times the risk of adverse neonatal events compared with no morbidity (95% CI 2.90-3.03). Associations were greatest for mothers who required assisted ventilation (RR 5.86, 95% CI 5.34-6.44), experienced uterine rupture (RR 4.54, 95% CI 3.73-5.51), or had cardiac complications (RR 4.39, 95% CI 3.98-4.84). Severe maternal morbidity was associated with ≥3 times the risk of neonatal death and hypoxic-ischemic encephalopathy and ≥10 times the risk of very preterm birth and bronchopulmonary dysplasia. CONCLUSIONS Severe maternal morbidity is associated with an elevated risk of adverse neonatal events. Better prevention of severe maternal morbidity may help reduce burden of severe neonatal morbidity.
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Affiliation(s)
- Ugochinyere Vivian Ukah
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut National de santé publique du Québec, Montreal, Quebec, Canada.
| | - Gabriel Côté-Corriveau
- Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Chantal Nelson
- Maternal and Infant Health Surveillance Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jessica Healy-Profitós
- Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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8
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Simpson AN, Sutradhar R, Benchimol EI, Chan WC, Porter J, Moore S, Dossa F, Huang V, Maxwell C, Targownik L, Liu N, Baxter NN. Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102463. [PMID: 38631434 DOI: 10.1016/j.jogc.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES It is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. METHODS Retrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15-55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. RESULTS We matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20-1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03; 95% CI 1-1.07). CONCLUSIONS The higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Joan Porter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Sarah Moore
- Department of Surgery, MacKenzie Health, Vaughan, ON
| | - Fahima Dossa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian Huang
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Laura Targownik
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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9
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Tsamantioti E, Sandström A, Muraca GM, Joseph KS, Remaeus K, Razaz N. Severe maternal morbidity surveillance, temporal trends and regional variation: A population-based cohort study. BJOG 2024; 131:811-822. [PMID: 37798853 DOI: 10.1111/1471-0528.17686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To quantify temporal trends and regional variation in severe maternal morbidity (SMM) in Sweden. DESIGN Cohort study. POPULATION Live birth and stillbirth deliveries in Sweden, 1999-2019. METHODS Types and subtypes of SMM were identified, based on a standard list (modified for Swedish clinical setting after considering the frequency and validity of each indicator) using diagnoses and procedure codes, among all deliveries at ≥22 weeks of gestation (including complications within 42 days of delivery). Contrasts between regions were quantified using rate ratios (RRs) and 95% confidence intervals (95% CIs). Temporal changes in SMM types and subtypes were described. MAIN OUTCOME MEASURES Types and subtypes of SMM. RESULTS There were 59 789 SMM cases among 2 212 576 deliveries, corresponding to 270.2 (95% CI 268.1-272.4) per 10 000 deliveries. Composite SMM rates increased from 236.6 per 10 000 deliveries in 1999 to 307.3 per 10 000 deliveries in 2006, before declining to 253.8 per 10 000 deliveries in 2019. Changes in composite SMM corresponded with temporal changes in severe haemorrhage rates, which increased from 94.9 per 10 000 deliveries in 1999 to 169.3 per 10 000 deliveries in 2006, before declining to 111.2 per 10 000 deliveries in 2019. Severe pre-eclampsia, eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome (103.8 per 10 000 deliveries), severe haemorrhage (133.7 per 10 000 deliveries), sepsis, embolism, disseminated intravascular coagulation, shock and severe mental health disorders were the most common SMM types. Rates of embolism, disseminated intravascular coagulation and shock, acute renal failure, cardiac complications, sepsis and assisted ventilation increased, whereas rates of surgical complications, severe uterine rupture and anaesthesia complications declined. CONCLUSIONS The observed spatiotemporal variations in composite SMM and SMM types provide substantive insights and highlight regional priorities for improving maternal health.
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Affiliation(s)
- Eleni Tsamantioti
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Giulia M Muraca
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katarina Remaeus
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Xu Y, Zhu S, Song H, Lian X, Zeng M, He J, Shu L, Xue X, Xiao F. Comparison of the efficacy for early warning systems in predicting obstetric critical illness. Eur J Obstet Gynecol Reprod Biol 2024; 296:327-332. [PMID: 38520955 DOI: 10.1016/j.ejogrb.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To validate the accuracy of four early warning scores for early identification of women at risk. METHODS This was a retrospective study of pregnant women admitted in obstetrics Critical Care Unit (ICU). Capacity of the Modified Obstetric Early Warning Score (MOEWS), ICNARC Obstetric Early Warning Score (OEWS), Maternal Early Obstetric Warning System (MEOWS chart), and Maternal Early Warning Trigger (MEWT) were compared in predicting severe maternal morbidity. Area under receiver operator characteristic (AUROC) curve was used to evaluate the predictive performance of scoring system. RESULTS A total of 352 pregnant women were enrolled and 290 were identified with severe maternal morbidity. MOEWS was more sensitive than MEOWS chart, ICNARC OEWS and MEWT (96.9 % vs. 83.4 %, 66.6 % and 44.8 %). MEWT had the highest specificity (98.4 %), followed by MOEWS (83.9 %), ICNARC OEWS (75.8 %) and MEOWS chart (48.4 %). AUROC of MOEWS, ICNARC OEWS, MEOWS chart, and MEWT for prediction of maternal mortality were 0.91 (95 % CI: 0.874-0.945), 0.765(95 % CI: 0.71-0.82), 0.657(95 % CI: 0.577-0.738), and 0.716 (95 % CI, 0.659-0.773) respectively. MOEWS had the highest AUCs in the discrimination of serious complications in hypertensive disorders, cardiovascular disease, obstetric hemorrhage and infection. For individual vital signs, maximum diastolic blood pressure (DBP), maximum systolic blood pressure (SBP), maximum respiratory rate (RR) and peripheral oxygen saturation (SPO2) demonstrated greater predictive ability. CONCLUSION MOEWS is more accurate than ICNARC OEWS, MEOWS chart, and MEWT in predicting the deterioration of women. The prediction ability of DBP, SBP, RR and SPO2 are more reliable.
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Affiliation(s)
- Yonghui Xu
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Sha Zhu
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Hao Song
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Xiaoyuan Lian
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Maoni Zeng
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Ji He
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Lijuan Shu
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - XinSheng Xue
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China
| | - Fei Xiao
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Women's and Children's Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
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11
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Mehrabadi A, Brown MM, Woolcott C, Fahey J, Gagnon I, Allen VM. Accuracy of Uterine Rupture Captured Through Routinely Collected Data Among Pregnancies with a Previous Cesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102290. [PMID: 37981231 DOI: 10.1016/j.jogc.2023.102290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Azar Mehrabadi
- Departments of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Departments of Pediatrics, Dalhousie University, Halifax, NS.
| | - Mary M Brown
- Department of Mathematics & Statistics, University of New Brunswick, Saint John, NB
| | - Christy Woolcott
- Departments of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS; Departments of Pediatrics, Dalhousie University, Halifax, NS
| | - John Fahey
- Reproductive Care Program of Nova Scotia, Halifax, NS
| | - Irene Gagnon
- Reproductive Care Program of Nova Scotia, Halifax, NS
| | - Victoria M Allen
- Departments of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
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12
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Peng R, Tong Y, Yang M, Wang J, Yang L, Zhu J, Liu Y, Wang H, Shi Z, Liu Y. Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study. QJM 2024; 117:24-37. [PMID: 37773990 PMCID: PMC10849872 DOI: 10.1093/qjmed/hcad220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Maternal and neonatal disorders account for substantial health loss across the lifespan from early childhood. These problems may be related to health inequality. AIM To provide evidence for improvement in health policies regarding maternal and neonatal disorder inequity. DESIGN This was a population-based cross-sectional study based on 2019 Global Burden of Disease data. METHODS Annual cases and age-standardized rates (ASRs) of incidence, prevalence, death, and disability-adjusted life-years (DALYs) in maternal and neonatal disorders between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. Concentration curves and concentration indices were used to summarize the degree of socioeconomic-related inequality. RESULTS For maternal disorders, the global ASRs of incidence, prevalence, death and DALYs were 2889.4 (95% uncertainty interval (UI), 2562.9-3251.9), 502.9 (95% UI 418.7-598.0), 5.0 (95% UI 4.4-5.8) and 324.9 (95% UI 284.0-369.1) per 100 000 women in 2019, respectively. The ASRs of maternal disorders were all obviously reduced and remained pro-poor from 1990 to 2019. In neonatal disorders, the global ASRs of incidence, prevalence, death and DALYs were 363.3 (95% UI 334.6-396.8), 1239.8 (95% UI 1142.1-1356.7), 29.1 (95% UI 24.8-34.5) and 2828.3 (95% UI 2441.6-3329.6) per 100 000 people in 2019, respectively. The global ASRs of incidence, death and DALYs in neonatal disorders have remained pro-poor. However, the socioeconomic-related fairness in the ASR of neonatal disorder prevalence is being levelled. CONCLUSIONS The global burden of maternal and neonatal disorders has remained high, and socioeconomic-related inequality (pro-poor) tended not to change between 1990 and 2019.
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Affiliation(s)
- R Peng
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Y Tong
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - M Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - L Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - J Zhu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Yu Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - H Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, 610041, China
| | - Z Shi
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
| | - Ya Liu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, 610081, China
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13
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Baykemagn FT, Abreha GF, Zelelow YB, Berhe AK, Kahsay AB. Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:11. [PMID: 38166681 PMCID: PMC10759711 DOI: 10.1186/s12884-023-06199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Potentially life-threatening maternal conditions (PLTCs) is an important proxy indicator of maternal mortality and the quality of maternal health services. It is helpful to monitor the rates of severe maternal morbidity to evaluate the quality of maternal care, particularly in low- and lower-middle-income countries. This study aims to systematically identify and synthesize available evidence on PLTCs. METHODS We searched studies in English from 2009‒2023 in PubMed, the National Library of Medicine (NLM) Gateway, the POPLINE database, and the Science Direct website. The study team independently reviewed the illegibility criteria of the articles. Two reviewers independently appraised the included articles using the Joanna Briggs Instrument for observational studies. Disputes between the reviewers were resolved by consensus with a third reviewer. Meta-analysis was conducted in Stata version 16. The pooled proportion of PLTCs was calculated using the random effects model. The heterogeneity test was performed using the Cochrane Q test, and its level was determined using the I2 statistical result. Using Egger's test, the publication bias was assessed. RESULT Thirty-two cross-sectional, five case-control, and seven cohort studies published from 2009 to 2023 were included in the meta-analysis. The highest proportion of PLTC was 17.55% (95% CI: 15.51, 19.79) in Ethiopia, and the lowest was 0.83% (95% CI: 0.73, 0.95) in Iraq. The pooled proportion of PLTC was 6.98% (95% CI: 5.98-7.98). In the subgroup analysis, the pooled prevalence varied based on country income level: in low-income 13.44% (95% CI: 11.88-15.00) I2 = 89.90%, low-middle income 7.42% (95% CI: 5.99-8.86) I2 = 99.71%, upper-middle income 6.35% (95% CI: 4.21-8.50) I2 = 99.92%, and high-income 2.67% (95% CI: 2.34-2.99) I2 = 99.57%. Similarly, it varied based on the diagnosis criteria; WHO diagnosis criteria used 7.77% (95% CI: 6.10-9.44) I2 = 99.96% at P = 0.00, while the Centers for Disease Controls (CDC) diagnosis criteria used 2.19% (95% CI: 1.89-2.50) I2 = 99.41% at P = 0.00. CONCLUSION The pooled prevalence of PLTC is high globally, predominantly in low-income countries. The large disparity of potentially life-threatening conditions among different areas needs targeted intervention, particularly for women residing in low-income countries. The WHO diagnosis criteria minimize the underreporting of severe maternal morbidity. TRIAL REGISTRATION CRD42023409229.
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Affiliation(s)
- Fitiwi Tinsae Baykemagn
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia.
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
| | | | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Tigray, Ethiopia
| | - Abadi Kidanemariam Berhe
- School of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia
- Tigray Health Research Institute, Mekelle, Ethiopia
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14
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Barakauskas VE, Bohn MK, Branch E, Boutin A, Albert A, Luke S, Dittrick M, Higgins V, Adeli K, Vallance H, Jung B, Dooley K, Dahlgren-Scott L, Chan WS. Mining the Gap: Deriving Pregnancy Reference Intervals for Hematology Parameters Using Clinical Datasets. Clin Chem 2023; 69:1374-1384. [PMID: 37947280 DOI: 10.1093/clinchem/hvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Physiological changes during pregnancy invalidate use of general population reference intervals (RIs) for pregnant people. The complete blood count (CBC) is commonly ordered during pregnancy, but few studies have established pregnancy RIs suitable for contemporary Canadian mothers. Prospective RI studies are challenging to perform during pregnancy while retrospective techniques fall short as pregnancy and health status are not readily available in the laboratory information system (LIS). This study derived pregnancy RIs retrospectively using LIS data linked to provincial perinatal registry data. METHODS A 5-year healthy pregnancy cohort was defined from the British Columbia Perinatal Data Registry and linked to laboratory data from two laboratories. CBC and differential RIs were calculated using direct and indirect approaches. Impacts of maternal and pregnancy characteristics, such as age, body mass index, and ethnicity, on laboratory values were also assessed. RESULTS The cohort contained 143 106 unique term singleton pregnancies, linked to >972 000 CBC results. RIs were calculated by trimester and gestational week. Result trends throughout gestation aligned with previous reports in the literature, although differences in exact RI limits were seen for many tests. Trimester-specific bins may not be appropriate for several CBC parameters that change rapidly within trimesters, including red blood cells (RBCs), some leukocyte parameters, and platelet counts. CONCLUSIONS Combining information from comprehensive clinical databases with LIS data provides a robust and reliable means for deriving pregnancy RIs. The present analysis also illustrates limitations of using conventional trimester bins during pregnancy, supporting use of gestational age or empirically derived bins for defining CBC normal values during pregnancy.
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Affiliation(s)
- Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary Kathryn Bohn
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Emma Branch
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Amelie Boutin
- Department of Pediatrics, Université Laval, and Reproduction, Mother and Youth Health Unit, CHU de Quebec-Université Laval Research Center, Quebec City, QC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Sabrina Luke
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
- Research and Surveillance Group, Perinatal Services British Columbia, Vancouver, BC, Canada
| | - Michelle Dittrick
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Victoria Higgins
- Clinical Biochemistry, DynaLIFE Medical Labs and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Khosrow Adeli
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hilary Vallance
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Benjamin Jung
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kent Dooley
- Clinical Biochemistry, LifeLabs Medical Laboratories, Victoria, BC, Canada
| | - Leanne Dahlgren-Scott
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Wee-Shian Chan
- Department of Medicine, BC Women's Hospital and Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Kuklina EV, Ewing AC, Satten GA, Callaghan WM, Goodman DA, Ferre CD, Ko JY, Womack LS, Galang RR, Kroelinger CD. Ranked severe maternal morbidity index for population-level surveillance at delivery hospitalization based on hospital discharge data. PLoS One 2023; 18:e0294140. [PMID: 37943788 PMCID: PMC10635479 DOI: 10.1371/journal.pone.0294140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Severe maternal morbidity (SMM) is broadly defined as an unexpected and potentially life-threatening event associated with labor and delivery. The Centers for Disease Control and Prevention (CDC) produced 21 different indicators based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) hospital diagnostic and procedure codes to identify cases of SMM. OBJECTIVES To examine existing SMM indicators and determine which indicators identified the most in-hospital mortality at delivery hospitalization. METHODS Data from the 1993-2015 and 2017-2019 Healthcare Cost and Utilization Project's National Inpatient Sample were used to report SMM indicator-specific prevalences, in-hospital mortality rates, and population attributable fractions (PAF) of mortality. We hierarchically ranked indicators by their overall PAF of in-hospital mortality. Predictive modeling determined if SMM prevalence remained comparable after transition to ICD-10-CM coding. RESULTS The study population consisted of 18,198,934 hospitalizations representing 87,864,173 US delivery hospitalizations. The 15 top ranked indicators identified 80% of in-hospital mortality; the proportion identified by the remaining indicators was negligible (2%). The top 15 indicators were: restoration of cardiac rhythm; cardiac arrest; mechanical ventilation; tracheostomy; amniotic fluid embolism; aneurysm; acute respiratory distress syndrome; acute myocardial infarction; shock; thromboembolism, pulmonary embolism; cerebrovascular disorders; sepsis; both DIC and blood transfusion; acute renal failure; and hysterectomy. The overall prevalence of the top 15 ranked SMM indicators (~22,000 SMM cases per year) was comparable after transition to ICD-10-CM coding. CONCLUSIONS We determined the 15 indicators that identified the most in-hospital mortality at delivery hospitalization in the US. Continued testing of SMM indicators can improve measurement and surveillance of the most severe maternal complications at the population level.
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Affiliation(s)
- Elena V. Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexander C. Ewing
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Glen A. Satten
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William M. Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David A. Goodman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia D. Ferre
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, United States of America
| | - Lindsay S. Womack
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, United States of America
| | - Romeo R. Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Charlan D. Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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16
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Ukah UV, Platt RW, Auger N, Lisonkova S, Ray JG, Malhamé I, Ayoub A, El-Chaâr D, Dayan N. Risk of recurrent severe maternal morbidity: a population-based study. Am J Obstet Gynecol 2023; 229:545.e1-545.e11. [PMID: 37301530 DOI: 10.1016/j.ajog.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Severe maternal morbidity is a composite indicator of maternal health and obstetrical care. Little is known about the risk of recurrent severe maternal morbidity in a subsequent delivery. OBJECTIVE This study aimed to estimate the risk of recurrent severe maternal morbidity in the next delivery after a complicated first delivery. STUDY DESIGN We analyzed a population-based cohort study of women with at least 2 singleton hospital deliveries between 1989 and 2021 in Quebec, Canada. The exposure was severe maternal morbidity in the first hospital-recorded delivery. The study outcome was severe maternal morbidity at the second delivery. Log-binomial regression models adjusted for maternal and pregnancy characteristics were used to generate relative risks and 95% confidence intervals comparing women with and without severe maternal morbidity at first delivery. RESULTS Among 819,375 women, 43,501 (3.2%) experienced severe maternal morbidity in the first delivery. The rate of severe maternal morbidity recurrence at second delivery was 65.2 vs 20.3 per 1000 in women with and without previous severe maternal morbidity (adjusted relative risk, 3.11; 95% confidence interval, 2.96-3.27). The adjusted relative risk for recurrence of severe maternal morbidity was greatest among women who had ≥3 different types of severe maternal morbidity at their first delivery, relative to those with none (adjusted relative risk, 5.50; 95% confidence interval, 4.26-7.10). Women with cardiac complication at first delivery had the highest risk of severe maternal morbidity in the next delivery. CONCLUSION Women who experience severe maternal morbidity have a relatively high risk of recurrent morbidity in the subsequent pregnancy. In women with severe maternal morbidity, these study findings have implications for prepregnancy counseling and maternity care in the next pregnancy.
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Affiliation(s)
- Ugochinyere Vivian Ukah
- Institut national de santé publique du Québec, Montreal, Canada; HealthPartners Institute, Pregnancy and Child Health Research Center, Bloomington, MN; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology and the BC Children's and Women's Hospital, The University of British Columbia, Vancouver, Canada
| | - Joel G Ray
- Department of Medicine and the Institute of Health Policy and Evaluation, University of Toronto, Toronto, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Canada
| | - Darine El-Chaâr
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
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17
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Auger N, Ukah UV, Wei SQ, Healy-Profitós J, Lo E, Dayan N. Impact of Covid-19 on risk of severe maternal morbidity. Crit Care 2023; 27:344. [PMID: 37670329 PMCID: PMC10481463 DOI: 10.1186/s13054-023-04584-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND We examined the risk of severe life-threatening morbidity in pregnant patients with Covid-19 infection. METHODS We conducted a population-based study of 162,576 pregnancies between March 2020 and March 2022 in Quebec, Canada. The main exposure was Covid-19 infection, including the severity, period of infection (antepartum, peripartum), and circulating variant (wildtype, alpha, delta, omicron). The outcome was severe maternal morbidity during pregnancy up to 42 days postpartum. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between Covid-19 infection and severe maternal morbidity using adjusted log-binomial regression models. RESULTS Covid-19 infection was associated with twice the risk of severe maternal morbidity compared with no infection (RR 2.02, 95% CI 1.76-2.31). Risks were elevated for acute renal failure (RR 3.01, 95% CI 1.79-5.06), embolism, shock, sepsis, and disseminated intravascular coagulation (RR 1.35, 95% CI 0.95-1.93), and severe hemorrhage (RR 1.49, 95% CI 1.09-2.04). Severe antepartum (RR 13.60, 95% CI 10.72-17.26) and peripartum infections (RR 20.93, 95% CI 17.11-25.60) were strongly associated with severe maternal morbidity. Mild antepartum infections also increased the risk, but to a lesser magnitude (RR 3.43, 95% CI 2.42-4.86). Risk of severe maternal morbidity was around 3 times greater during circulation of wildtype and the alpha and delta variants, but only 1.2 times greater during omicron. CONCLUSIONS Covid-19 infection during pregnancy increases risk of life-threatening maternal morbidity, including renal, embolic, and hemorrhagic complications. Severe Covid-19 infection with any variant in the antepartum or peripartum periods all increase the risk of severe maternal morbidity.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
| | - U Vivian Ukah
- Institut national de santé publique du Québec, Montreal, QC, Canada
- HealthPartners Institute, Pregnancy and Child Health Research Center, Bloomington, MN, USA
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, QC, Canada
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Ernest Lo
- Institut national de santé publique du Québec, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Natalie Dayan
- Department of Medicine, McGill University, Montreal, QC, Canada
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Bone JN, Joseph KS, Magee LA, Wang LQ, Mayer C, Lisonkova S. Pre-pregnancy body mass index and adverse maternal and perinatal outcomes in twins: A population retrospective cohort study. Int J Obes (Lond) 2023; 47:799-806. [PMID: 37202431 DOI: 10.1038/s41366-023-01320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To examine the association between pre-pregnancy BMI and severe maternal morbidity (SMM), perinatal death and severe neonatal morbidity in twin pregnancies. METHODS All twin births at ≥ 20 weeks gestation in British Columbia, Canada, from 2000 to 2017 were included. We estimated rates of SMM, a perinatal composite of death and severe morbidity, and its components per 10,000 pregnancies. Confounder-adjusted rate ratios (aRR) between pre-pregnancy BMI and outcomes were estimated using robust Poisson regression. RESULTS Overall, 7770 (368 underweight, 1704 overweight, and 1016 obese) women with twin pregnancy were included. The rates of SMM were: 271.1, 320.4, 270.0, and 225.9 in underweight, normal BMI, overweight and obese women, respectively. There was little association between obesity and any of the primary outcomes (e.g., aRR = 1.09, 95% CI = 0.85, 1.38 for composite perinatal outcome). Underweight women had higher rates of the composite perinatal adverse outcome (aRR = 1.79, 95% CI = 1.32-2.43), driven by increased rates of severe respiratory distress syndrome, and neonatal death. CONCLUSIONS There was no evidence of elevated risk of adverse outcomes among twin pregnancies of women who were overweight or obese. Risk was higher in underweight women, who may require specific care when carrying twins.
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Affiliation(s)
- Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada.
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Li Qing Wang
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
| | - Chantal Mayer
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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19
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Rezaeiahari M, Brown CC, Ali MM, Tilford JM, Magann EF. Identification of racial/ethnic disparities associated with severe maternal morbidity using the Arkansas All-Payer Claims Database (2013-2017). Birth 2023; 50:339-348. [PMID: 35670090 DOI: 10.1111/birt.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/28/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of maternal characteristics on the odds of severe maternal morbidity (SMM) through 42 days postpartum. STUDY DESIGN We conducted a retrospective observational study of 77 172 births using birth certificate and insurance claims data from the Arkansas All Payers Claims Database, years 2013-2017, to identify racial disparities associated with SMM for births between April 1, 2014, and November 19, 2017. METHODS Multiple logistic regression was used to examine the effect of sociodemographic factors and clinical comorbidities on the odds of SMM among non-Hispanic white ("white"), non-Hispanic Black ("Black"), and Hispanic women. RESULTS The rate of SMM was 227.41 per 10 000 births, with Black women (330 per 10 000 births; 95% CI: 296.16-366.38), having a significantly higher rates than white women (197; 95% CI: 171.72-225.84) and Hispanic women (180; 95% CI: 155.86-207.54). After adjusting for maternal demographics, birth-related clinical variables, and comorbidities, SMM remained higher among Black women (aOR 1.37; 95% CI 1.11-1.70) relative to white women. CONCLUSIONS Comorbidities, socioeconomic factors, and other factors did not fully explain the Black-white disparities in SMM. Persistent disparities in the rates of SMM throughout 42 days postpartum among Black women relative to white women points to the need for higher quality, more equitable care for women of color in the fist months postpartum.
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Affiliation(s)
- Mandana Rezaeiahari
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Clare C Brown
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mir M Ali
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Everett F Magann
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Kern-Goldberger AR, Howell EA, Srinivas SK, Levine LD. What we talk about when we talk about severe maternal morbidity: a call to action to critically review severe maternal morbidity as an outcome measure. Am J Obstet Gynecol MFM 2023; 5:100882. [PMID: 36736823 PMCID: PMC10121757 DOI: 10.1016/j.ajogmf.2023.100882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Severe maternal morbidity has historically functioned as an umbrella term to define major, potentially life-threatening obstetrical, medical, and surgical complications of pregnancy. There is no overarching or consensus definition of the constellation of conditions that have been used variably to define severe maternal morbidity, although it is clear that having a well-honed definition of severe maternal morbidity is important for research, quality improvement, and health policy purposes. Although severe maternal morbidity may ultimately elude a single unifying definition because different features may be relevant depending on context and modality of data acquisition, it is valuable to explore the intellectual frameworks and various applications of severe maternal morbidity in current practice, and to consider the potential benefit of more consolidated terminology for maternal morbidity.
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Affiliation(s)
- Adina R Kern-Goldberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Elizabeth A Howell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sindhu K Srinivas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa D Levine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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21
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Kaur J, Thompson C, McLeod S, Varner C. Application of the Modified Early Obstetrical Warning System (MEOWS) in postpartum patients in the emergency department. CAN J EMERG MED 2023:10.1007/s43678-023-00500-7. [PMID: 37088841 DOI: 10.1007/s43678-023-00500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/24/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Over the last two decades, there has been a steady rise in severe maternal morbidity and pregnancy-related deaths in Canada and the USA. The Modified Early Obstetric Warning System (MEOWS) is a risk stratification tool designed to predict severe maternal morbidity and mortality and has been validated for use in obstetrical wards. The objective of this study was to determine if MEOWS could accurately identify patients at risk of severe maternal morbidity and mortality in the ED setting. METHODS This was a chart review of patients presenting to an academic tertiary care centre (annual ED census 65,000) with a postpartum complaint within 6 weeks of delivery between May 2020 and March 2022. The exposure was the presence of a trigger, defined as one severely abnormal (red) or two mildly abnormal (yellow) physiological measurements during the ED visit. The diagnostic accuracy of the tool to identify patients at risk of severe maternal morbidity severe maternal morbidity or mortality was estimated by calculating the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS Two hundred and sixty-seven patients were included, of which 21 (7.9%) met the criteria for severe maternal morbidity. There were no maternal deaths. Overall, the sensitivity of the MEOWS tool was 85.7% (95% CI 63.7-97.0%), specificity was 67.9% (95% CI 61.7-73.7%), positive predictive value was 18.6% (95% CI 15.1-22.7%), and negative predictive value was 98.2% (95% CI 95.1-99.4%). Severe preeclampsia and eclampsia were the most common outcome category of severe maternal morbidity, representing 16 (76.2%) cases. Most patients (86.5%) were discharged directly from the ED, and 90.0% did not return within 30 days. CONCLUSIONS This study is the first to explore the utility of MEOWS in postpartum ED patients. The presence of a MEOWS trigger at ED triage or the first ED nursing assessment was associated with severe maternal morbidity. Thus, MEOWS may be a valuable tool to identify postpartum patients at risk of severe outcomes early in an ED visit.
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Affiliation(s)
- Jeeventh Kaur
- Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada
| | - Cameron Thompson
- Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada
- Sinai Health, Toronto, ON, Canada
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada
- Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine Varner
- Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada.
- Sinai Health, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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22
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Ford ND, DeSisto CL, Galang RR, Kuklina EV, Sperling LS, Ko JY. Cardiac Arrest During Delivery Hospitalization : A Cohort Study. Ann Intern Med 2023; 176:472-479. [PMID: 36913690 PMCID: PMC10264156 DOI: 10.7326/m22-2750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Estimates of cardiac arrest occurring during delivery guide evidence-based strategies to reduce pregnancy-related death. OBJECTIVE To investigate rate of, maternal characteristics associated with, and survival after cardiac arrest during delivery hospitalization. DESIGN Retrospective cohort study. SETTING U.S. acute care hospitals, 2017 to 2019. PARTICIPANTS Delivery hospitalizations among women aged 12 to 55 years included in the National Inpatient Sample database. MEASUREMENTS Delivery hospitalizations, cardiac arrest, underlying medical conditions, obstetric outcomes, and severe maternal complications were identified using codes from the International Classification of Diseases, 10th Revision, Clinical Modification. Survival to hospital discharge was based on discharge disposition. RESULTS Among 10 921 784 U.S. delivery hospitalizations, the cardiac arrest rate was 13.4 per 100 000. Of the 1465 patients who had cardiac arrest, 68.6% (95% CI, 63.2% to 74.0%) survived to hospital discharge. Cardiac arrest was more common among patients who were older, were non-Hispanic Black, had Medicare or Medicaid, or had underlying medical conditions. Acute respiratory distress syndrome was the most common co-occurring diagnosis (56.0% [CI, 50.2% to 61.7%]). Among co-occurring procedures or interventions examined, mechanical ventilation was the most common (53.2% [CI, 47.5% to 59.0%]). The rate of survival to hospital discharge after cardiac arrest was lower with co-occurring disseminated intravascular coagulation (DIC) without or with transfusion (50.0% [CI, 35.8% to 64.2%] or 54.3% [CI, 39.2% to 69.5%], respectively). LIMITATIONS Cardiac arrests occurring outside delivery hospitalizations were not included. The temporality of arrest relative to the delivery or other maternal complications is unknown. Data do not distinguish cause of cardiac arrest, such as pregnancy-related complications or other underlying causes among pregnant women. CONCLUSION Cardiac arrest was observed in approximately 1 in 9000 delivery hospitalizations, among which nearly 7 in 10 women survived to hospital discharge. Survival was lowest during hospitalizations with co-occurring DIC. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Nicole D Ford
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (N.D.F., C.L.D., R.R.G.)
| | - Carla L DeSisto
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (N.D.F., C.L.D., R.R.G.)
| | - Romeo R Galang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (N.D.F., C.L.D., R.R.G.)
| | - Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (E.V.K., L.S.S.)
| | - Laurence S Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (E.V.K., L.S.S.)
| | - Jean Y Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and U.S. Public Health Service, Commissioned Corps, Rockville, Maryland (J.Y.K.)
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23
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Côté-Corriveau G, Luu TM, Bilodeau-Bertrand M, Auger N. Association of Maternal and Neonatal Birth Outcomes With Subsequent Pediatric Transplants. Transplantation 2023; 107:720-728. [PMID: 36251381 DOI: 10.1097/tp.0000000000004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We identified maternal and neonatal birth characteristics that were associated with organ or tissue transplants during childhood. METHODS We designed a retrospective cohort study of the population of children born between 2006 and 2019 in Quebec, Canada. The exposure included birth complications such as congenital anomaly, neonatal blood transfusion, and oligohydramnios. The main outcome measure was organ or tissue transplantation before 14 y of age. We categorized transplants according to type (major organs versus superficial tissues). To determine the association of birth characteristics with risk of pediatric transplant, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards models adjusted for potential confounders. RESULTS The cohort comprised 1 038 375 children with 7 712 678 person-years of follow-up, including 436 children who had transplants before 14 y of age. Birth complications were predominantly associated with major organ transplants. Congenital anomaly was associated with heart or lung (HR, 10.41; 95% CI, 5.33-20.33) and kidney transplants (HR, 13.69; 95% CI, 7.48-25.06), compared with no anomaly. Neonatal blood transfusion was associated with all major organ transplants, compared with no transfusion. Maternal complications were not as strongly associated with the risk of childhood transplant, although oligohydramnios was associated with 16.84 times (95% CI, 8.09-35.02) the risk of kidney transplant, compared with no oligohydramnios. CONCLUSIONS Adverse birth outcomes such as congenital anomaly, neonatal blood transfusion, and maternal oligohydramnios are associated with a greater risk of transplantation before 14 y of age. Maternal and neonatal birth outcomes may be useful predictors of transplantation.
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Affiliation(s)
- Gabriel Côté-Corriveau
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | - Marianne Bilodeau-Bertrand
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
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24
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Joseph KS, Young CB, Muraca GM, Boutin A, Razaz N, John S, Lisonkova S, Wilson RD. Hospital factors associated with maternal and neonatal outcomes of deliveries to patients with a previous cesarean delivery: an ecological study. CMAJ 2023; 195:E178-E186. [PMID: 36746486 PMCID: PMC9904811 DOI: 10.1503/cmaj.220928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recommendations for deliveries of pregnant patients with a previous cesarean delivery and the type of hospitals deemed safe for these deliveries have evolved in recent years, although no studies have examined hospital factors and associated safety. We sought to evaluate maternal and neonatal outcomes among patients with a previous cesarean delivery by hospital tier and volume. METHODS We carried out an ecological study of singleton live births delivered at term gestation to patients with a previous cesarean delivery in all Canadian hospitals (excluding Quebec), 2013-2019. We obtained data from the Discharge Abstract Database of the Canadian Institute for Health Information. The primary outcomes were severe maternal morbidity or mortality (SMMM), and serious neonatal morbidity or mortality (SNMM). We used regression modelling to examine hospital tier (tier 4 hospitals being those that provide the highest level of care) and volume; we also identified hospitals with high rates of SMMM and SNMM using within-tier comparisons and comparisons with the overall rate. RESULTS We included 235 442 deliveries to patients with a previous cesarean delivery; SMMM and SNMM rates were 14.6 per 1000 deliveries and 4.6 per 1000 live births, respectively. Among patients with a parity of 1, SMMM rates were lower in tier 1 hospitals (adjusted incidence rate ratio [IRR] 0.68, 95% confidence interval [CI] 0.52-0.89) and higher in tier 4 hospitals (adjusted IRR 1.41, 95% CI 1.05-1.91) than in tier 2 hospitals; SNMM rates did not differ by hospital tier. Rates of SNMM increased with increasing hospital volume (adjusted IRR 1.02, 95% CI 1.00-1.04) and increasing rates of vaginal birth after cesarean delivery (adjusted IRR 1.02, 95% CI 1.01-1.04). Most hospitals had relatively low SMMM and SNMM rates, although a few hospitals in each tier and volume category had significantly higher rates than others. INTERPRETATION Adverse maternal and neonatal outcomes among patients with a previous cesarean delivery showed no clear pattern of decreasing SMMM and SNMM with increasing tiers of service and hospital volume. All hospitals, irrespective of tier or size, should continually review their rates of adverse maternal and neonatal outcomes.
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Affiliation(s)
- K S Joseph
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Carmen B Young
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Giulia M Muraca
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Amélie Boutin
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Neda Razaz
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Sid John
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - R Douglas Wilson
- Department of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Liu N, Ray JG. Short-Term Adverse Outcomes After Mifepristone-Misoprostol Versus Procedural Induced Abortion : A Population-Based Propensity-Weighted Study. Ann Intern Med 2023; 176:145-153. [PMID: 36592459 DOI: 10.7326/m22-2568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Prior studies comparing first-trimester pharmaceutical induced abortion (IA) with procedural IA were prone to selection bias, were underpowered to assess serious adverse events (SAEs), and did not account for confounding by indication. Starting in 2017, mifepristone-misoprostol was dispensed at no cost in outpatient pharmacies across Ontario, Canada. OBJECTIVE To compare short-term risk for adverse outcomes after early IA by mifepristone-misoprostol versus by procedural IA. DESIGN Population-based cohort study. SETTING Ontario, Canada. PATIENTS All women who had first-trimester IA. MEASUREMENTS A total of 39 856 women dispensed mifepristone-misoprostol as outpatients were compared with 65 176 women undergoing procedural IA at 14 weeks' gestation or earlier within nonhospital outpatient clinics (comparison 1). A total of 39 856 women prescribed mifepristone-misoprostol were compared with 8861 women undergoing ambulatory hospital-based procedural IA at an estimated 9 weeks' gestation or less (comparison 2). The primary composite outcome was any SAE within 42 days after IA, including severe maternal morbidity, end-organ damage, intensive care unit admission, or death. A coprimary broader outcome comprised any SAE, hemorrhage, retained products of conception, infection, or transfusion. Stabilized inverse probability of treatment weighting accounted for confounding between exposure groups. RESULTS Mean age at IA was about 29 years (SD, 7); 33% were primigravidae. Six percent resided in rural areas, and 25% resided in low-income neighborhoods. In comparison 1, SAEs occurred among 133 women after mifepristone-misoprostol IA (3.3 per 1000) versus 114 after procedural IA (1.8 per 1000) (relative risk [RR], 1.87 [95% CI, 1.44 to 2.43]; absolute risk difference [ARD], 1.5 per 1000 [CI, 0.9 to 2.2]). The respective rates of any adverse event were 28.9 versus 12.4 per 1000 (RR, 2.33 [CI, 2.11 to 2.57]; ARD, 16.5 per 1000 [CI, 14.5 to 18.4]). In comparison 2, SAEs occurred among 133 (3.4 per 1000) and 27 (3.3 per 1000) women, respectively (RR, 1.04 [CI, 0.61 to 1.78]). The respective rates of any adverse event were 31.2 versus 24.9 per 1000 (RR, 1.25 [CI, 1.04 to 1.51]). LIMITATION A woman prescribed mifepristone-misoprostol may not have taken the medication, and the exact gestational age at IA was not always known. CONCLUSION Although rare, short-term adverse events are more likely after mifepristone-misoprostol IA than procedural IA, especially for less serious adverse outcomes. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Ning Liu
- ICES and University of Toronto, Toronto, Ontario, Canada (N.L.)
| | - Joel G Ray
- Departments of Medicine and Obstetrics and Gynecology, St. Michael's Hospital, ICES, and University of Toronto, Toronto, Ontario, Canada (J.G.R.)
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A new modified obstetric early warning score for prognostication of severe maternal morbidity. BMC Pregnancy Childbirth 2022; 22:901. [PMID: 36464694 PMCID: PMC9720996 DOI: 10.1186/s12884-022-05216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Maternal mortality is still a major challenge for health systems, while severe maternal complications are the primary causes of maternal death. Our study aimed to determine whether severe maternal morbidity is effectively predicted by a newly proposed Modified Obstetric Early Warning Score (MOEWS) in the setting of an obstetric intensive care unit (ICU). METHODS A retrospective study of pregnant women admitted in the ICU from August 2019 to August 2020 was conducted. MOEWS was calculated 24 h before and 24 h after admission in the ICU, and the highest score was taken as the final value. For women directly admitted from the emergency department, the worst value before admission was collected. The aggregate performance of MOEWS in predicting critical illness in pregnant women was evaluated and finally compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. RESULTS A total of 352 pregnant women were enrolled; 290 women (82.4%) with severe maternal morbidity were identified and two of them died (0.6%). The MOEWSs of women with serious obstetric complications were significantly higher than those of women without serious obstetric complications [8(6, 10) vs. 4(2, 4.25), z = -10.347, P < 0.001]. MOEWSs of 24 h after ICU admission had higher sensitivity, specificity and AUROC than MOEWSs of 24 h before ICU admission. When combining the two MOEWSs, sensitivity of MOEWS was 99.3% (95% CI: 98-100), specificity 75.8% (95% CI: 63-86), positive predictive value (PPV) 95.1% (95% CI: 92-97) and negative predictive value (NPV) 95.9% (95% CI: 86-100). The areas under the receiver operator characteristic (ROC) curves of MOEWS were 0.92 (95% CI: 0.88-0.96) and 0.70 (95% CI: 0.63-0.76) of the APACHE II score. CONCLUSION The newly proposed MOEWS has an excellent ability to identify critically ill women early and is more effective than APACHE II. It will be a valuable tool for discriminating severe maternal morbidity and ultimately improve maternal health.
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Association of Endometriosis and Severe Maternal Morbidity. Obstet Gynecol 2022; 140:1008-1016. [PMID: 36357981 DOI: 10.1097/aog.0000000000004969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association between endometriosis and risk of severe maternal morbidity (SMM). METHODS We conducted a population-based retrospective cohort study of 2,412,823 deliveries at hospitals in Quebec, Canada, between 1989 and 2019. The exposure was surgically confirmed endometriosis. Patients were classified as having active endometriosis during pregnancy, inactive endometriosis during pregnancy, a diagnosis of endometriosis postpregnancy, or no endometriosis. The outcome was SMM, including by a range of life-threatening maternal conditions during pregnancy or up to 42 days postdelivery. We computed rates of SMM and used log binomial regression to assess the association with endometriosis (risk ratio [RR]; 95% CI), adjusted for maternal characteristics. RESULTS Severe maternal morbidity occurred in 46.2 of 1,000 patients with endometriosis, compared with 30.7 of 1,000 patients without endometriosis. Relative to no exposure, endometriosis was associated with 1.43 times the risk of SMM (95% CI 1.36-1.51). Patients with endometriosis that was active during pregnancy had a greater risk of SMM (RR 1.93; 95% CI 1.76-2.11). Active endometriosis was associated with the risk of severe preeclampsia and eclampsia, severe hemorrhage, hysterectomy, cardiac complications, embolism, shock, sepsis, and intensive care unit admission. Inactive endometriosis was less strongly associated with these outcomes. CONCLUSION Pregnant patients with endometriosis, especially active endometriosis, have a greater risk of SMM and may benefit from closer follow-up to prevent severe complications of pregnancy.
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Ukah UV, Li X, Wei SQ, Healy-Profitós J, Dayan N, Auger N. Black-White disparity in severe cardiovascular maternal morbidity: A systematic review and meta-analysis. Am Heart J 2022; 254:35-47. [PMID: 35944667 DOI: 10.1016/j.ahj.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To synthesize existing evidence on Black-White disparities in the prevalence of severe cardiovascular maternal morbidity. METHODS We searched MEDLINE, EMBASE, and CINAHL for observational studies published before July 31, 2021 that compared the risk of severe cardiovascular maternal morbidity between Black and White women. The outcome was severe cardiovascular maternal morbidity, including acute myocardial infarction, peripartum cardiomyopathy, and stroke during pregnancy, delivery, or postpartum. We extracted relevant information including adjusted and unadjusted effect estimates. We used random-effects models to estimate the pooled association between race and severe cardiovascular maternal morbidity, presented as odds ratios with 95% confidence intervals for the comparison of Black women relative to White women. RESULTS We included 18 studies that met the eligibility criteria for systematic review and meta-analysis. All studies were conducted in the United States and included a total of 7,656,876 Black women and 26,412,600 White women. Compared with White women, Black women had an increased risk of any severe cardiovascular maternal morbidity (adjusted odds ratio, 1.90; 95% confidence interval, 1.54-2.33). Black women were at risk of acute myocardial infarction (adjusted odds ratio, 1.38; 95% confidence interval, 1.14-1.68), peripartum cardiomyopathy (adjusted odds ratio, 1.71; 95% confidence interval, 1.51-1.94), and stroke (adjusted odds ratio, 2.13; 95% confidence interval, 1.39-3.26). CONCLUSIONS Black women have a considerably higher risk of severe cardiovascular maternal morbidity than White women, including acute myocardial infarction, peripartum cardiomyopathy, and stroke. Reducing inequality in adverse cardiovascular outcomes of pregnancy between Black and White women should be prioritized.
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Affiliation(s)
- Ugochinyere Vivian Ukah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Xinting Li
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Departments of Medicine and Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Institut national de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
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Muacevic A, Adler JR. A Systematic Review of Severe Maternal Morbidity in High-Income Countries. Cureus 2022; 14:e29901. [PMID: 36348883 PMCID: PMC9632680 DOI: 10.7759/cureus.29901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/25/2023] Open
Abstract
With declining maternal mortality rates in high-income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs. The objectives are to compare definitions and criteria used to identify SMM and identify the main causes and risk factors contributing to SMM in HICs. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched for articles published between 2010 and 2022, results were filtered, and 10 studies were critically appraised. Six of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stays and admission to the intensive care unit (ICU) were suggested as additional criteria. Disease-based criteria were shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe hemorrhage, hypertensive disorders, and preeclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and cesarean delivery were the most common. This literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several causes and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and 10 studies. Further research should aim to investigate how these criteria compare with previous sources of criteria and discern the association of weight and race risk factors with SMM.
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Observational study of birth outcomes in children with inborn errors of metabolism. Pediatr Res 2022; 92:1181-1187. [PMID: 35058604 DOI: 10.1038/s41390-022-01946-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We examined the birth outcomes of children with inborn errors of metabolism detected at birth or later in life. METHODS We carried out a retrospective cohort study of 1733 children with inborn errors of metabolism and 1,033,693 unaffected children born in Canada between 2006 and 2019. Primary outcomes included preterm birth, low birth weight, congenital anomalies, and other neonatal complications. We estimated adjusted risk ratios (RR) and 95% confidence intervals (CI) for the association of inborn errors of metabolism with each outcome. RESULTS Children with inborn errors of metabolism had 2.51 times the risk of preterm birth (95% CI 2.27-2.77) and 3.08 times the risk of low birth weight (95% CI 2.77-3.42) compared with unaffected children. Disorders of mineral and lipoprotein metabolism were more strongly associated with adverse birth outcomes. Inborn errors of metabolism were associated with congenital anomalies (RR 2.62; 95% CI 2.36-2.90), particularly abdominal wall defects (RR 8.35; 95% CI 5.18-13.44). Associations were present for errors of metabolism diagnosed both at birth and later in life. CONCLUSIONS Children with inborn errors of metabolism, whether detected at birth or later, are at high risk of adverse birth outcomes and congenital anomalies. IMPACT Inborn errors of metabolism may affect fetal development, but the association with adverse birth outcomes is not well characterized. This study indicates that children with inborn errors of metabolism are at risk of preterm birth, neonatal jaundice, congenital anomalies, and a range of other adverse birth outcomes. Mothers of children with inborn errors of metabolism are at risk of preeclampsia and cesarean delivery. Adverse birth outcomes may be a first sign of inborn errors of metabolism that merit increased screening.
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Masterson JA, Adamestam I, Beatty M, Boardman JP, Johnston P, Joss J, Lawrence H, Litchfield K, Walsh TS, Wise A, Wood R, Weir CJ, Denison FC, Lone NI. Severe maternal morbidity in Scotland. Anaesthesia 2022; 77:971-980. [PMID: 35820195 PMCID: PMC9544155 DOI: 10.1111/anae.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- J. A. Masterson
- Department of Anaesthesia, Critical Care and Pain MedicineUniversity of EdinburghUK
| | | | - M. Beatty
- Department of Anaesthesia, Critical Care and Pain MedicineRoyal Infirmary of EdinburghUK
| | - J. P. Boardman
- MRC Centre for Reproductive HealthQueen's Medical Research Institute, University of EdinburghUK
| | - P. Johnston
- Department of Anaesthesia, Critical Care and Pain MedicineNinewells HospitalDundeeUK
| | - J. Joss
- Department of Anaesthesia, Critical Care and Pain MedicineNinewells HospitalDundeeUK
| | | | - K. Litchfield
- Department of Anaesthesia, Critical Care and Pain MedicineGlasgow Royal InfirmaryGlasgowUK
| | - T. S. Walsh
- Department of Anaesthesia, Critical Care and Pain MedicineRoyal Infirmary of EdinburghUK
- Usher InstituteUniversity of EdinburghUK
| | - A. Wise
- Department of Anaesthesia, Critical Care and Pain MedicineRoyal Infirmary of EdinburghUK
| | - R. Wood
- Usher InstituteUniversity of EdinburghUK
- Public Health ScotlandGlasgowUK
| | - C. J. Weir
- Usher InstituteUniversity of EdinburghUK
| | - F. C. Denison
- MRC Centre for Reproductive HealthQueen's Medical Research Institute, University of EdinburghUK
| | - N. I. Lone
- Department of Anaesthesia, Critical Care and Pain MedicineRoyal Infirmary of EdinburghUK
- Usher InstituteUniversity of EdinburghUK
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Sabr Y, Lisonkova S, Skoll A, Brant R, Velez MP, Joseph KS. Severe maternal morbidity and maternal mortality associated with assisted reproductive technology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:978-986. [PMID: 35738557 DOI: 10.1016/j.jogc.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the association between use of assisted reproductive technologies (ART) and severe maternal morbidity and maternal mortality (SMM). METHODS We carried out a cohort study that included all hospital deliveries at ≥20 weeks gestation in Canada (excluding Québec) between April 2009 and March 2018. Outcomes of interest included composite SMM and SMM types (e.g., severe preeclampsia, HELLP syndrome, and eclampsia; severe hemorrhage; acute renal failure). Multivariable regression was used to estimate crude and adjusted rate ratios (RR and aRR) and 95% confidence intervals (CI). RESULTS The study included 2 535 056 women, of whom 72 023 (2.8%) delivered following the use of ART. The composite SMM rate for women who used ART was 34.7 per 1000 deliveries (95% CI 33.0-36.0) versus 11.5 per 1000 deliveries (95% CI 11.4-11.6) for women who did not use ART (RR 3.01; 95% CI 2.89-3.14). ART use was associated with SMM types such as severe preeclampsia, HELLP syndrome, and eclampsia (RR 3.50; 95% CI 3.27-3.73), severe hemorrhage (RR 3.58, 95% CI 3.27-3.92), and acute renal failure (RR 6.79; 95% CI 5.78-7.98). Associations between ART and composite SMM were attenuated but remained elevated after adjusting for maternal characteristics (aRR 2.34; 95% CI 2.24-2.45). Women who used ART and had a multi-fetal pregnancy had a 4.7 times higher rate of composite SMM compared with women who did not use ART and delivered singletons. CONCLUSION Women who deliver following the use of ART have increased risks of SMM and require counselling that includes mention of the lower risks of SMM associated with ART-conceived singleton pregnancy.
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Affiliation(s)
- Yasser Sabr
- Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC.
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC
| | - Amanda Skoll
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver, BC
| | - Maria P Velez
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
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Carmichael SL, Abrams B, El Ayadi A, Lee HC, Liu C, Lyell DJ, Lyndon A, Main EK, Mujahid M, Tian L, Snowden JM. Ways Forward in Preventing Severe Maternal Morbidity and Maternal Health Inequities: Conceptual Frameworks, Definitions, and Data, from a Population Health Perspective. Womens Health Issues 2022; 32:213-218. [PMID: 34972599 DOI: 10.1016/j.whi.2021.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Alison El Ayadi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Can Liu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; California Maternal Quality Care Collaborative, Stanford University, Stanford, California
| | - Mahasin Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon; Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Snelgrove JW, Simpson AN, Sutradhar R, Everett K, Liu N, Baxter NN. Preeclampsia and Severe Maternal Morbidity During the COVID-19 Pandemic: A Population-Based Cohort Study in Ontario, Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:777-784. [PMID: 35395419 PMCID: PMC8979839 DOI: 10.1016/j.jogc.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023]
Abstract
Objective Significant changes to the delivery of obstetrical care that occurred with the onset of the COVID-19 pandemic may be associated with higher risks of adverse maternal outcomes. We evaluated preeclampsia/HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome and composite severe maternal morbidity (SMM) among pregnant people who gave birth during the COVID-19 pandemic and compared these data with those of people who gave birth before the pandemic in Ontario, Canada. Methods This was a population-based, retrospective cohort study using linked administrative data sets from ICES. Data on pregnant people at ≥20 weeks gestation who gave birth between March 15, 2020, and September 30, 2021, were compared with those of pregnant people who gave birth within the same date range for the years 2015–2019. We used multivariable logistic regression to assess the effect of the pandemic period on the odds of preeclampsia/HELLP syndrome and composite SMM, adjusting for maternal baseline characteristics and comorbidities. Results There were no differences between the study periods in the adjusted odds ratios (aORs) for preeclampsia/HELLP syndrome among primiparous (aOR 1.00; 95% CI 0.91–1.11) and multiparous (aOR 0.94; 95% CI 0.81–1.09) patients and no differences for composite SMM (primiparous, aOR 1.00; 95% CI 0.95–1.05; multiparous, aOR 1.01; 95% CI 0.95–1.08). Conclusion Adverse maternal outcomes were not higher among pregnant people who gave birth during the first 18 months of the COVID-19 pandemic in Ontario, Canada, when compared with those who gave birth before the pandemic.
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D'Souza R, Seymour RJ, Knight M, Dzakpasu S, Joseph KS, Thorne S, Ospina MB, Barrett J, Cook J, Fell DB, Scott H, Metcalfe A, van den Akker T, Lapinsky S, Skeith L, Murray-Davis B, Shah P, Forte M, Ashraf R, Chundamala J, Hutchinson SA, Chen KK, Malhamé I. Feasibility of establishing a Canadian Obstetric Survey System (CanOSS) for severe maternal morbidity: a study protocol. BMJ Open 2022; 12:e061093. [PMID: 35321901 PMCID: PMC8943762 DOI: 10.1136/bmjopen-2022-061093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Severe maternal morbidity (SMM)-an unexpected pregnancy-associated maternal outcome resulting in severe illness, prolonged hospitalisation or long-term disability-is recognised by many, as the preferred indicator of the quality of maternity care, especially in high-income countries. Obtaining comprehensive details on events and circumstances leading to SMM, obtained through maternity units, could complement data from large epidemiological studies and enable targeted interventions to improve maternal health. The aim of this study is to assess the feasibility of gathering such data from maternity units across Canadian provinces and territories, with the goal of establishing a national obstetric survey system for SMM in Canada. METHODS AND ANALYSIS We propose a sequential explanatory mixed-methods study. We will first distribute a cross-sectional survey to leads of all maternity units across Canada to gather information on (1) Whether the unit has a system for reviewing SMM and the nature and format of this system, (2) Willingness to share anonymised data on SMM by direct entry using a web-based platform and (3) Respondents' perception on the definition and leading causes of SMM at a local level. This will be followed by semistructured interviews with respondent groups defined a priori, to identify barriers and facilitators for data sharing. We will perform an integrated analysis to determine feasibility outcomes, a narrative description of barriers and facilitators for data-sharing and resource implications for data acquisition on an annual basis, and variations in top-5 causes of SMM. ETHICS AND DISSEMINATION The study has been approved by the Mount Sinai and Hamilton Integrated Research Ethics Boards. The study findings will be presented at annual scientific meetings of the Society of Obstetricians and Gynaecologists of Canada, North American Society of Obstetric Medicine, and International Network of Obstetric Survey Systems and published in an open-access peer-reviewed Obstetrics and Gynaecology or General Internal Medicine journal.
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Affiliation(s)
- Rohan D'Souza
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics & Gynaecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca J Seymour
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, Ontario, Canada
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Susie Dzakpasu
- Maternal and Infant Health Section, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - K S Joseph
- Department of Obstetrics & Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Sara Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, University of Toronto, Toronto, Ontario, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jon Barrett
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, Ontario, Canada
| | - Jocelynn Cook
- Society of Obstetricians and Gynaecologists, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, Children's Hospital of Eastern Ontario (CHEO) Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Scott
- Department of Obstetrics & Gynaecology, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Department of Obstetrics & Gynaecology, and Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas van den Akker
- Department of Obstetrics & Gynaecology, Leiden University, Leiden, The Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Stephen Lapinsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Skeith
- Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Beth Murray-Davis
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Prakesh Shah
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Milena Forte
- Department of Family and Community Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rizwana Ashraf
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, Ontario, Canada
| | - Josie Chundamala
- Department of Obstetrics & Gynaecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A Hutchinson
- Department of Obstetrics & Gynaecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth K Chen
- Departments of Medicine and Obstetrics & Gynecology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Isabelle Malhamé
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Nik Hazlina NH, Norhayati MN, Shaiful Bahari I, Mohamed Kamil HR. The Prevalence and Risk Factors for Severe Maternal Morbidities: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:861028. [PMID: 35372381 PMCID: PMC8968119 DOI: 10.3389/fmed.2022.861028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionMaternal mortality and severe maternal morbidity remain major public health problems globally. Understanding their risk factors may result in better treatment solutions and preventive measures for maternal health. This review aims to identify the prevalence and risk factors of severe maternal morbidity (SMM) and maternal near miss (MNM).MethodsA systematic review and meta-analysis was conducted to assess the prevalence and risk factors of SMM and MNM. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic search was performed in the MEDLINE (PubMed), CINAHL (EBSCOhost), and Science Direct databases for articles published between 2011 and 2020.ResultsTwenty-four of the 44 studies included were assessed as being of good quality and having a low risk of bias. The prevalence of SMM and MNM was 2.45% (95% CI: 2.03, 2.88) and 1.68% (95% CI: 1.42, 1.95), respectively. The risk factors for SMM included history of cesarean section (OR [95% CI]: 1.63 [1.43, 1.87]), young maternal age (OR [95% CI]: 0.71 [0.60, 0.83]), singleton pregnancy (OR [95% CI]: 0.42 [0.32, 0.55]), vaginal delivery (OR [95% CI]: 0.11 [0.02, 0.47]), coexisting medical conditions (OR [95% CI]: 1.51 [1.28, 1.78]), and preterm gestation (OR [95% CI]: 0.14 [0.08, 0.23]). The sole risk factor for MNM was a history of cesarean section (OR [95% CI]: 2.68 [1.41, 5.10]).ConclusionsMaternal age, coexisting medical conditions, history of abortion and cesarean delivery, gestational age, parity, and mode of delivery are associated with SMM and MNM. This helps us better understand the risk factors and their strength of association with SMM and MNM. Thus, initiatives such as educational programs, campaigns, and early detection of risk factors are recommended. Proper follow-up is important to monitor the progression of maternal health during the antenatal and postnatal periods.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226137, identifier: CRD42021226137.
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Affiliation(s)
- Nik Hussain Nik Hazlina
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- *Correspondence: Mohd Noor Norhayati
| | - Ismail Shaiful Bahari
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Ukah UV, Dayan N, Potter BJ, Paradis G, Ayoub A, Auger N. Severe Maternal Morbidity and Long-Term Risk of Cardiovascular Hospitalization. Circ Cardiovasc Qual Outcomes 2022; 15:e008393. [PMID: 35098729 DOI: 10.1161/circoutcomes.121.008393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe maternal morbidity is rising, yet the association with cardiovascular disease is not clear. We examined the risk of cardiovascular hospitalization up to 3 decades after having a pregnancy complicated by severe maternal morbidity. METHODS We analyzed a longitudinal cohort of 1 336 846 women who were pregnant between 1989 and 2019 in Quebec, Canada. The main exposure measure was severe maternal morbidity in any pregnancy, including severe preeclampsia, acute renal failure, sepsis, and other life-threatening conditions. Using time-varying Cox regression models, we compared the adjusted risk of hospitalization for cardiovascular disease up to 3 decades after pregnancy for women with severe maternal morbidity relative to women without severe morbidity. RESULTS Five percent of women had severe maternal morbidity. Overall, there were 68 287 cardiovascular hospitalizations during 21 725 672 person-years of follow-up in the cohort. Compared with no morbidity, women with any severe morbidity had a greater risk of cardiovascular hospitalization (hazard ratio [HR], 1.77 [95% CI, 1.72-1.82]). The association was the greatest within the first year of delivery (HR, 4.42 [95% CI, 3.77-5.19]) but persisted beyond 15 years (HR, 1.44 [95% CI, 1.37-1.51]). Having a cardiac complication (HR, 5.37 [95% CI, 4.65-6.20]), cerebrovascular accident (HR, 3.82 [95% CI, 2.94-4.96]), or acute renal failure (HR, 2.60 [95% CI, 2.15-3.14]) during pregnancy was strongly associated with future cardiovascular hospitalization. CONCLUSIONS Women with severe maternal morbidity have a greater risk of cardiovascular disease after pregnancy, both in the short and long term. These women may benefit from active surveillance for cardiovascular disease.
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Affiliation(s)
- U Vivian Ukah
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada (U.V.U., N.D., G.P., N.A.).,Institut national de santé publique du Québec, Montreal, Quebec, Canada (U.V.U., G.P., A.A., N.A.)
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada (U.V.U., N.D., G.P., N.A.).,Departments of Medicine, Obstetrics and Gynecology, and Research Institute, McGill University Health Centre, Montreal, Quebec, Canada (N.D.)
| | - Brian J Potter
- Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Montreal, Quebec, Canada (B.J.P.).,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada (B.J.P., A.A., N.A.)
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada (U.V.U., N.D., G.P., N.A.).,Institut national de santé publique du Québec, Montreal, Quebec, Canada (U.V.U., G.P., A.A., N.A.)
| | - Aimina Ayoub
- Institut national de santé publique du Québec, Montreal, Quebec, Canada (U.V.U., G.P., A.A., N.A.).,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada (B.J.P., A.A., N.A.)
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada (U.V.U., N.D., G.P., N.A.).,Institut national de santé publique du Québec, Montreal, Quebec, Canada (U.V.U., G.P., A.A., N.A.).,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada (B.J.P., A.A., N.A.).,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec, Canada (N.A.)
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Thorne SA, Cook JL, D'Souza R. The Role of National Pregnancy Surveillance Systems in Improving Maternal Mortality and Morbidity: The Next Steps for Canada. Can J Cardiol 2021; 37:1904-1907. [PMID: 34474122 DOI: 10.1016/j.cjca.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sara A Thorne
- Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Jocelynn L Cook
- Department of Obstetrics and Gynecology, University of Ottawa, and the Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Rohan D'Souza
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Rincón-López JV, Larrotta-Castillo D, Estrada-Orozco K, Gaitán-Duarte H. Structure and roles of rapid response teams for adult care in high complexity hospitals: Scoping review. ACTA ACUST UNITED AC 2021; 72:171-192. [PMID: 34506704 PMCID: PMC8425358 DOI: 10.18597/rcog.3671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022]
Abstract
Objective A significant proportion of hospitalized patients experience severe clinical deterioration that may result in adverse events, unexpected cardiac arrest, or death. Rapid response teams (RRTs) have been created to reduce the frequency and prevent the consequences of these events. The objective of this scoping review is to describe the structure, role and results of the implementation of RRTs in the hospital context, with a focus on gynecological surgery and obstetric care. Materials and methods A search was conducted in the Medline via Pubmed, Embase via OVID, LILACS, Cochrane Library and Open Gray medical databases. The search included descriptive and analytical observational studies, experimental studies and qualitative studies that included RRTs in high complexity healthcare institutions or teaching hospitals. Two researchers selected the studies and extracted data pertaining to the structure, roles and team activation criteria, response times or tools to assess their performance. No date or publication status restrictions were applied. Studies in English, Spanish and Portuguese were included. A narrative synthesis of the findings is made. Results Overall, 15,833 titles were retrieved, of which 15 studies met the inclusion criteria. Only one study mentions the use of RRTs in obstetric services. RRTs have a multidisciplinary structure and they must be available at least 12 hours a day. The roles of RRTs include identification of patients who are deteriorating, especially outside the intensive care setting, and of patients with underlying conditions or triggering events that increase the risk of cardiac arrest. In addition, they implement rapid multifaceted interventions that include pharmacological treatments, cardiopulmonary procedures, and they develop communication and training activities. Tools for team activation and care process assessment are available. Conclusion The structure and roles of RRTs are clearly described, making it possible to assemble them in high complexity hospitals. Further research is required to explore risks and benefits of using RRTs to mitigate harm in patients with adverse events and to compare effectiveness and safety between code activation and RRT strategies in obstetrics services.
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Abstract
OBJECTIVE We assessed whether bariatric surgery before pregnancy lowers the risk of severe maternal morbidity to a level comparable to no obesity. SUMMARY OF BACKGROUND DATA Obesity is a risk factor for severe maternal morbidity, but the potential for bariatric surgery to reduce the risk has not been studied. METHODS We analyzed a retrospective cohort of 2,412,075 deliveries between 1989 and 2019 in Quebec, Canada. The main exposure measures were bariatric surgery before pregnancy and obesity without bariatric surgery, compared with no obesity. The outcome was severe maternal morbidity, a composite of life-threatening pregnancy complications. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between bariatric surgery and severe maternal morbidity, adjusted for maternal characteristics. RESULTS A total of 2654 deliveries (0.1%) were in women who had bariatric surgery, and 70,041 (29.0 per 1000) were in women who had severe maternal morbidity. Risk of severe maternal morbidity was not significantly elevated for bariatric surgery (RR 1.20; 95% CI 0.98-1.46), but was greater for obesity compared with no obesity (RR 1.60; 95% CI 1.55-1.64). Bariatric surgery was not associated with morbidities such as severe preeclampsia, sepsis, and cardiac complications compared with no obesity, but obesity was associated with elevated risks of these and other severe morbidities. Bariatric surgery was associated, however, with intensive care unit admission, compared with no obesity. CONCLUSIONS Pregnant women with prior bariatric surgery have similar risks as nonobese women for most types of severe maternal morbidity, except for intensive care unit admission.
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Wei SQ, Bilodeau-Bertrand M, Lo E, Auger N. Effect of publicly funded assisted reproductive technology on maternal and infant outcomes: a pre- and post-comparison study. Hum Reprod 2021; 36:219-228. [PMID: 33246340 DOI: 10.1093/humrep/deaa270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/02/2020] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Does publicly funded assisted reproductive technology result in improved maternal and infant outcomes? SUMMARY ANSWER Publicly funded ART in Quebec was associated with reduced risks of preeclampsia, cesarean delivery, preterm birth, low birth weight and other adverse outcomes. WHAT IS KNOWN ALREADY Publicly funded ART programs that provide free access to single embryo transfer are known to decrease the rate of multiple pregnancy, but the impact on other pregnancy outcomes is unknown. STUDY DESIGN, SIZE, DURATION We conducted a pre- and post-comparison study of 597 416 pregnancies conceived between July 2008 and September 2015 in Quebec, Canada, a region where public funding of ART began in August 2010. PARTICIPANTS/MATERIALS, SETTING, METHODS We included all pregnant women who conceived by ART (n = 14 309) or spontaneously (n = 583 107) and delivered a live or stillborn infant in hospitals of Quebec. The main exposure measure was conception before versus during the publicly funded ART program. Outcomes included measures of maternal and infant morbidity and mortality. We estimated risk ratios (RR) and 95% confidence intervals for the association of publicly funded ART with maternal and infant outcomes using log-binomial regression models adjusted for maternal characteristics. MAIN RESULTS AND THE ROLE OF CHANCE In this study, 2638 pregnancies were conceived by ART before, and 11 671 were conceived by ART, during public funding. Compared with no public funding, ART funding was associated with reduced risks of severe maternal morbidity (RR 0.64, 95% CI 0.50-0.83), preeclampsia (RR 0.55, 95% CI 0.44-0.68), cesarean delivery (RR 0.83, 95% CI 0.77-0.89), preterm birth (RR 0.67, 95% CI 0.60-0.75), low birth weight (RR 0.63, 95% CI 0.55-0.72), severe neonatal morbidity (RR 0.75, 95% CI 0.57-0.99) and neonatal intensive care unit admission (RR 0.65, 95% CI 0.53-0.78). When multiple pregnancies were excluded, ART funding continued to be associated with a lower risk of preeclampsia (RR 0.61, 95% CI 0.48-0.79) and preterm birth (RR 0.85, 95% CI 0.73-0.99). However, ART funding was associated with increased risk of gestational diabetes. LIMITATIONS, REASONS FOR CAUTION We had no information on the type of ART, number of in-vitro fertilization cycles or number of embryos transferred. We lacked data on body mass index, ethnicity and smoking and cannot rule out residual confounding. WIDER IMPLICATION OF THE FINDINGS Our findings suggest that publicly funded ART programs that encourage single embryo transfer may have substantial benefits for a range of maternal and infant outcomes, beyond prevention of multiple births. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grant 6D02363004 from the Public Health Agency of Canada. N.A. acknowledges a career award from the Fonds de recherche du Québec-Santé (34695). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Shu Qin Wei
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Canada
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
| | - Marianne Bilodeau-Bertrand
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
| | - Ernest Lo
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Nathalie Auger
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
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Severe Maternal Morbidity and Risk of Mortality Beyond the Postpartum Period. Obstet Gynecol 2021; 137:277-284. [PMID: 33416296 DOI: 10.1097/aog.0000000000004223] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine long-term risks of mortality after a pregnancy complicated by severe maternal morbidity. METHODS We analyzed a longitudinal cohort of 1,229,306 women who delivered in the province of Quebec, Canada from 1989 through 2016. Severe maternal morbidity included conditions such as cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening complications. The outcome was in-hospital mortality after the last pregnancy, categorized as postpartum (42 days or fewer after delivery) and long-term (43 days to 29 years after delivery). We estimated hazard ratios (HRs) ofr mortality with 95% CI for severe maternal morbidity compared with no severe morbidity, using Cox regression models adjusted for maternal characteristics. RESULTS Severe maternal morbidity occurred in 2.9% of women. The mortality rate associated with severe maternal morbidity was 0.86 per 1,000 person-years compared with 0.41 per 1,000 person-years for no morbidity. Compared with no morbidity, severe maternal morbidity was associated with two times the rate of death any time after delivery (95% CI 1.81-2.20). Severe cardiac complications (HR 7.00, 85% CI 4.94-9.91), acute renal failure (HR 4.35, 95% CI 2.66-7.10), and cerebrovascular accidents (HR 4.03, 95% CI 2.17-7.48) were the leading morbidities associated with mortality after 42 days. CONCLUSION Women who experience severe maternal morbidity have an accelerated risk of mortality beyond the postpartum period compared with women who do not experience severe morbidity. More intensive clinical follow-up may be merited for women with serious pregnancy complications.
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Breman RB, Phillippi JC, Tilden E, Paul J, Barr E, Carlson N. Challenges in the Triage Care of Low-Risk Laboring Patients: A Comparison of 2 Models of Practice. J Perinat Neonatal Nurs 2021; 35:123-131. [PMID: 33900241 PMCID: PMC9083212 DOI: 10.1097/jpn.0000000000000552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample (N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.
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Affiliation(s)
- Rachel Blankstein Breman
- University of Maryland School of Nursing, Baltimore (Dr Breman and Mr Barr); Vanderbilt School of Nursing, Nashville, Tennessee (Dr Phillippi); School of Nursing and School of Medicine, Oregon Health and Science University, Portland (Dr Tilden); Perinatal Behavioral Health Clinic, Weymouth, Massachusetts (Dr Paul); and Emory University School of Nursing, Atlanta, Georgia (Dr Carlson)
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Brown KK, Smith JG, Jeffers RL, Jean Pierre C. Association between nurse work environment and severe maternal morbidity in high-income countries: A systematic review and call to action. J Adv Nurs 2020; 77:1206-1217. [PMID: 33245160 DOI: 10.1111/jan.14672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/25/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify evidence related to association between the nurse work environment and severe maternal morbidity in high-income countries. DESIGN Quantitative Systematic review. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PubMed/Medline, and Scopus were systematically searched for studies published in English from January 1990-December 2019. Studies were selected based on a priori eligibility criteria. REVIEW METHODS Two independent reviewers used a two-phase screening process. First, the reviewers assessed the eligibility of studies based on titles and abstracts; followed by assessing the full text of all remaining studies based on the eligibility criteria. An adapted version of the Joanna Briggs Institute data extraction tool was created to extract relevant information from studies reviewed during the second screening phase. RESULTS Of the 535 de-duplicated articles examined by two independent reviewers, there were no eligible empirical studies that assessed the association between nurse work environment and severe maternal morbidity. CONCLUSION There is a critical gap in knowledge regarding how characteristics of the nurse work environment may influence severe maternal morbidity in high-income countries. Future directions for nursing research include using available maternal health surveillance hospital-level data, conducting high-quality studies, and using evidence-based frameworks to guide future studies. Future directions for nursing practice include leveraging professional learning communities for nursing education and training and leveraging quality improvement initiatives. IMPACT As the first known systematic review of its kind, this 'empty review' provides evidence of a lacking body of literature on the association between nurse work environment, as a modifiable organizational characteristic and preventable severe maternal morbidity in high-income countries. This article provides a call to action in the form of five recommendations for future nursing research and practice, which could serve to elucidate research, practice, and policy opportunities to reduce preventable severe maternal morbidity in high-income countries.
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Affiliation(s)
- Kyrah K Brown
- University of Texas at Arlington College of Nursing and Health Innovation, Arlington, TX, USA
| | - Jessica G Smith
- University of Texas at Arlington College of Nursing and Health Innovation, Arlington, TX, USA
| | | | - Claudy Jean Pierre
- University of Texas at Arlington College of Nursing and Health Innovation, Arlington, TX, USA
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Knight M. Defining severe maternal morbidity-When is it time to stop? Paediatr Perinat Epidemiol 2020; 34:384-385. [PMID: 32291770 DOI: 10.1111/ppe.12675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Dzakpasu S, Deb‐Rinker P, Arbour L, Darling EK, Kramer MS, Liu S, Luo W, Murphy PA, Nelson C, Ray JG, Scott H, VandenHof M, Joseph KS. Severe maternal morbidity surveillance: Monitoring pregnant women at high risk for prolonged hospitalisation and death. Paediatr Perinat Epidemiol 2020; 34:427-439. [PMID: 31407359 PMCID: PMC7383693 DOI: 10.1111/ppe.12574] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no international consensus on the definition and components of severe maternal morbidity (SMM). OBJECTIVES To propose a comprehensive definition of SMM, to create an empirically justified list of SMM types and subtypes, and to use this to examine SMM in Canada. METHODS Severe maternal morbidity was defined as a set of heterogeneous maternal conditions known to be associated with severe illness and with prolonged hospitalisation or high case fatality. Candidate SMM types/subtypes were evaluated using information on all hospital deliveries in Canada (excluding Quebec), 2006-2015. SMM rates for 2012-2016 were quantified as a composite and as SMM types/subtypes. Rate ratios and population attributable fractions (PAF) associated with overall and specific SMM types/subtypes were estimated in relation to length of hospital stay (LOS > 7 days) and case fatality. RESULTS There were 22 799 cases of SMM subtypes (among 1 418 545 deliveries) that were associated with a prolonged LOS or high case fatality. Between 2012 and 2016, the composite SMM rate was 16.1 (95% confidence interval [CI] 15.9, 16.3) per 1000 deliveries. Severe pre-eclampsia and HELLP syndrome (514.6 per 100 000 deliveries), and severe postpartum haemorrhage (433.2 per 100 000 deliveries) were the most common SMM types, while case fatality rates among SMM subtypes were highest among women who had cardiac arrest and resuscitation (241.1 per 1000), hepatic failure (147.1 per 1000), dialysis (67.6 per 1000), and cerebrovascular accident/stroke (51.0 per 1000). The PAF for prolonged hospital stay related to SMM was 17.8% (95% CI 17.3, 18.3), while the PAF for maternal death associated with SMM was 88.0% (95% CI 74.6, 94.4). CONCLUSIONS The proposed definition of SMM and associated list of SMM subtypes could be used for standardised SMM surveillance, with rate ratios and PAFs associated with specific SMM types/subtypes serving to inform clinical practice and public health policy.
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Affiliation(s)
- Susie Dzakpasu
- Maternal, Child and Youth Health Division, Centre for Surveillance and Applied ResearchPublic Health Agency of CanadaOttawaONCanada
| | - Paromita Deb‐Rinker
- Maternal, Child and Youth Health Division, Centre for Surveillance and Applied ResearchPublic Health Agency of CanadaOttawaONCanada
| | - Laura Arbour
- Department of Medical GeneticsUniversity of British ColumbiaVictoriaBCCanada
| | | | - Michael S. Kramer
- Department of Pediatrics and of Epidemiology and BiostatisticsMcGill UniversityMontrealQCCanada
| | - Shiliang Liu
- Maternal, Child and Youth Health Division, Centre for Surveillance and Applied ResearchPublic Health Agency of CanadaOttawaONCanada
| | - Wei Luo
- Maternal, Child and Youth Health Division, Centre for Surveillance and Applied ResearchPublic Health Agency of CanadaOttawaONCanada
| | - Phil A. Murphy
- Perinatal Program of Newfoundland and LabradorSt. John’sNFLCanada
| | - Chantal Nelson
- Maternal, Child and Youth Health Division, Centre for Surveillance and Applied ResearchPublic Health Agency of CanadaOttawaONCanada
| | - Joel G. Ray
- Department of MedicineUniversity of TorontoTorontoONCanada
| | - Heather Scott
- Department of Obstetrics and GynaecologyDalhousie UniversityHalifaxNSCanada
| | - Michiel VandenHof
- Department of Obstetrics and GynaecologyDalhousie UniversityHalifaxNSCanada
| | - K. S. Joseph
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverBCCanada
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Davidson AJF, Park AL, Berger H, Aoyama K, Harel Z, Cook JL, Ray JG. Risk of severe maternal morbidity or death in relation to elevated hemoglobin A1c preconception, and in early pregnancy: A population-based cohort study. PLoS Med 2020; 17:e1003104. [PMID: 32427997 PMCID: PMC7236974 DOI: 10.1371/journal.pmed.1003104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relation between prepregnancy average glucose concentration and a woman's risk of severe maternal morbidity (SMM) is unknown. The current study evaluated whether an elevated preconception hemoglobin A1c (A1c) is associated with SMM or maternal death among women with and without known prepregnancy diabetes mellitus (DM). METHODS AND FINDINGS A population-based cohort study was completed in Ontario, Canada, where there is universal healthcare. The main cohort included 31,225 women aged 16-50 years with a hospital live birth or stillbirth from 2007 to 2015, and who had an A1c measured within 90 days before conception, including 28,075 women (90%) without known prepregnancy DM. The main outcome was SMM or maternal mortality from 23 weeks' gestation up to 42 days postpartum. Relative risks (RRs) were generated using modified Poisson regression, adjusting for the main covariates of maternal age, multifetal pregnancy, world region of origin, and tobacco/drug dependence. The mean maternal age was 31.1 years. Overall, SMM or death arose among 682 births (2.2%). The RR of SMM or death was 1.16 (95% CI 1.14-1.19; p < 0.001) per 0.5% increase in A1c and 1.16 (95% CI 1.13-1.18; p < 0.001) after adjusting for the main covariates. The adjusted relative risk (aRR) was increased among those with (1.11, 95% CI 1.07-1.14; p < 0.001) and without (1.15, 95% CI 1.02-1.29; p < 0.001) known prepregnancy diabetes, and upon further adjusting for body mass index (BMI) (1.15, 95% CI 1.11-1.20; p < 0.001), or chronic hypertension and prepregnancy serum creatinine (1.11, 95% CI 1.04-1.18; p = 0.002). The aRR of SMM or death was 1.31 (95% CI 1.06-1.62; p = 0.01) in those with a preconception A1c of 5.8%-6.4%, and 2.84 (95% CI 2.31-3.49; p < 0.001) at an A1c > 6.4%, each relative to an A1c < 5.8%. Among those without previously recognized prepregnancy diabetes and whose A1c was >6.4%, the aRR of SMM or death was 3.25 (95% CI 1.76-6.00; p < 0.001). Study limitations include that selection bias may have incorporated less healthy women tested for A1c, and BMI was unknown for many women. CONCLUSIONS Our findings indicate that women with an elevated A1c preconception may be at higher risk of SMM or death in pregnancy or postpartum, including those without known prepregnancy DM.
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Affiliation(s)
| | - Alison L. Park
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Howard Berger
- University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kazuyoshi Aoyama
- University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ziv Harel
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jocelynn L. Cook
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Joel G. Ray
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St. Michael’s Hospital, Toronto, Ontario, Canada
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