Abstract
Objectives
While the rates of maternal mortality in developed countries have remained low in recent years, rates of severe maternal morbidity (SMM) are still increasing in high income countries. As a result, SMM is currently used as a measure of maternity care level. The aim of this study was to investigate the prevalence and risk factors of SMM surrounding childbirth.
Methods
A nested case-control study was performed between the years 2013–2018. SMM was defined as peripartum hospitalization involving intensive care unit (ICU). A comparison was conducted between parturient with SMM to those without, randomly matched for delivery mode and date of birth in a 1:1 ratio. Multivariable logistic regression models were used to evaluate the independent association between SMM and different maternal and pregnancy characteristics.
Results
During the study period, 96,017 live births took place, of which 144 (1.5 per 1,000 live births-0.15%) involved SMM with ICU admissions. Parturient with SMM were more likely to have a history of 2 or more pregnancy losses (18.2% vs. 8.3%, p = 0.004), deliver preterm (48.9% vs. 8.8%, p < 0.001), and suffer from placenta previa (11.9% vs. 1.5%, p < 0.001), and/or placenta accreta (9.7% vs. 1.5%, p = 0.003). Several significant and independent risk factors for SMM were noted in the multivariable regression models: preterm delivery, history of ≥ 2 pregnancy losses, grand-multiparity, Jewish ethnicity, and abnormal placentation (previa or accreta).
Conclusions for Practice
SMM rates in our cohort were lower than reported in developed countries. An independent association exists between peripartum maternal ICU admissions and several demographic and clinical risk factors, including preterm birth and abnormal placentation.
Significance
Severe maternal morbidity (SMM) is a key measure of maternity care quality. In recent years, as maternal mortality rates decline significantly in developed countries and due to its higher incidence, SMM has been suggested as a surrogate for quality assessment of maternity care evaluation.
AbstractSection What this Study adds?SMM rate appear to decrease during the study period, from 1.56 to 2013 to 1.12 per 1,000 in 2018. An independent association exists between peripartum maternal ICU admissions and several demographic and clinical risk factors: abnormal placentation (placenta previa or placenta accreta), preterm delivery (< 37 weeks), grand multiparity (≥ 5), history of recurrent pregnancy loss, and Jewish ethnicity (as opposed to Bedouin). These associations were independent of each other and additionally adjusted for several clinically relevant confounders.
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Data Availability
The data that support the findings of this study are available upon request from the corresponding author, Ben-Ayoun Danielle.
Code Availability
The code of this study is available upon request from the corresponding author, Ben-Ayoun Danielle.
Abbreviations
- SMM:
-
severe maternal morbidity
- ICU:
-
intensive care unit
- SUMC:
-
Soroka University Medical Center
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Acknowledgements
This study was conducted as part of the requirements for MD degree of Danielle Ben-Ayoun from the Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev.
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All authors contributed to the study conception and design. Material preparation and data collection were preformed by Ben-Ayoun Danielle. Material design and analysis were performed by Walfisch Asnat, Wainstock Tamar, Imterat Majdi, and Ben-Ayoun Danielle. The first draft of the manuscript was written by Ben-Ayoun Danielle and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Ben-Ayoun, D., Walfisch, A., Wainstock, T. et al. Trend and risk Factors for Severe Peripartum Maternal morbidity - a population-based Cohort Study. Matern Child Health J 27, 719–727 (2023). https://doi.org/10.1007/s10995-022-03568-2
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DOI: https://doi.org/10.1007/s10995-022-03568-2