Severe maternal morbidity surveillance, temporal trends and regional variation: A population-based cohort study.
epidemiology
near-miss events
obstetrics
pregnancy complications
severe maternal morbidity
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
05 Oct 2023
05 Oct 2023
Historique:
revised:
12
09
2023
received:
12
06
2023
accepted:
18
09
2023
medline:
6
10
2023
pubmed:
6
10
2023
entrez:
6
10
2023
Statut:
aheadofprint
Résumé
To quantify temporal trends and regional variation in severe maternal morbidity (SMM) in Sweden. Cohort study. Live birth and stillbirth deliveries in Sweden, 1999-2019. 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. Types and subtypes of SMM. 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. The observed spatiotemporal variations in composite SMM and SMM types provide substantive insights and highlight regional priorities for improving maternal health.
Identifiants
pubmed: 37798853
doi: 10.1111/1471-0528.17686
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Swedish Research Council for Health, Working life and Welfare
ID : 4-2702/2019
Informations de copyright
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Références
Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, et al. Severe maternal morbidity in Canada, 1991-2001. CMAJ. 2005;173(7):759-764.
Diguisto C, Saucedo M, Kallianidis A, Bloemenkamp K, Bødker B, Buoncristiano M, et al. Maternal mortality in eight European countries with enhanced surveillance systems: descriptive population based study. BMJ. 2022;379:e070621.
Brace V, Penney G, Hall M. Quantifying severe maternal morbidity: a Scottish population study. BJOG. 2004;111(5):481-484.
Dzakpasu S, Deb-Rinker P, Arbour L, Darling EK, Kramer MS, Liu S, et al. Severe maternal morbidity in Canada: temporal trends and regional variations, 2003-2016. J Obstet Gynaecol Can. 2019;41(11):1589-1598.e16.
Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health. 2018;15(1):31-43.
Geller SE, Rosenberg D, Cox SM, Brown ML, Simonson L, Driscoll CA, et al. The continuum of maternal morbidity and mortality: factors associated with severity. Am J Obstet Gynecol. 2004;191(3):939-944.
Ray JG, Park AL, Dzakpasu S, Dayan N, Deb-Rinker P, Luo W, et al. Prevalence of severe maternal morbidity and factors associated with maternal mortality in Ontario, Canada. JAMA Netw Open. 2018;1(7):e184571.
Dzakpasu S, Deb-Rinker P, Arbour L, Darling EK, Kramer MS, Liu S, et al. Severe maternal morbidity surveillance: monitoring pregnant women at high risk for prolonged hospitalisation and death. Paediatr Perinat Epidemiol. 2020;34(4):427-439.
Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol. 2016;215(3):B17-B22.
Snowden JM, Lyndon A, Kan P, El Ayadi A, Main E, Carmichael SL. Severe maternal morbidity: a comparison of definitions and data sources. Am J Epidemiol. 2021;190(9):1890-1897.
Severe maternal morbidity in the United States. Available from: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html. Accessed 11 Oct 2022.
Belanoff C, Declercq ER, Diop H, Gopal D, Kotelchuck M, Luke B, et al. Severe maternal morbidity and the use of assisted reproductive Technology in Massachusetts. Obstet Gynecol. 2016;127(3):527-534.
Aoyama K, Ray JG, Pinto R, Hill A, Scales DC, Lapinsky SE, et al. Temporal variations in incidence and outcomes of critical illness among pregnant and postpartum women inCanada: a population-based observational study. J Obstet Gynaecol Can. 2019;41(5):631-640.
Leitao S, Manning E, Corcoran P, San Lazaro Campillo I, Greene RA, Severe Morbidity Maternal Group. Severe maternal morbidity in Ireland Annual Report 2019. 2021.
Masterson JA, Adamestam I, Beatty M, Boardman JP, Johnston P, Joss J, et al. Severe maternal morbidity in Scotland. Anaesthesia. 2022;77(9):971-980.
Say L, Pattinson RC, Gülmezoglu AM. WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health. 2004;1(1):3.
Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381(9879):1747-1755.
National Medical Birth Register. [cited 2022]. Available from: https://www.socialstyrelsen.se/en/statistics-and-data/registers/national-medical-birth-register/. Accessed 14 Oct 2022.
Cnattingius S, Källén K, Sandström A, Rydberg H, Månsson H, Stephansson O, et al. The Swedish medical birth register during five decades: documentation of the content and quality of the register. Eur J Epidemiol. 2023;38(1):109-120.
National Patient Register. Available from: https://www.socialstyrelsen.se/en/statistics-and-data/registers/national-patient-register/. Accessed 14 Oct 2022.
Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaëlsson K, Neovius M, et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125-136.
Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120(5):1029-1036.
Kuehn BM. Detailed maternal mortality data suggest more than 4 in 5 pregnancy-related deaths in US are preventable. JAMA. 2022;328:1893-1895.
Wahlberg A, Rööst M, Haglund B, Högberg U, Essén B. Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study. BJOG. 2013;120(13):1605-1611; discussion 12.
Liu C, Wall-Wieler E, Urquia M, Carmichael SL, Stephansson O. Severe maternal morbidity among migrants with insecure residency status in Sweden 2000-2014: a population-based cohort study. J Migr Health. 2020;1-2:100006.
Guglielminotti J, Wong CA, Friedman AM, Li G. Racial and ethnic disparities in death associated with severe maternal morbidity in the United States: failure to rescue. Obstet Gynecol. 2021;137(5):791-800.
Deneux-Tharaux C, Bouvier-Colle M-H. 585: severe acute maternal morbidity in France: the epimoms population-based study. Am J Obstet Gynecol. 2017;216(1):S345-S346.
Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in The Netherlands: a nationwide population-based study of 371,000 pregnancies. BJOG. 2008;115(7):842-850.
Bouvier-Colle MH, Mohangoo AD, Gissler M, Novak-Antolic Z, Vutuc C, Szamotulska K, et al. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. BJOG. 2012;119(7):880-889; discussion 90.
Ladfors LV, Muraca GM, Zetterqvist J, Butwick AJ, Stephansson O. Postpartum haemorrhage trends in Sweden using the Robson ten group classification system: a population-based cohort study. BJOG. 2022;129(4):562-571.
Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF. Investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007;114(6):751-759.
Cameron CA, Roberts CL, Olive EC, Ford JB, Fischer WE. Trends in postpartum haemorrhage. Aust N Z J Public Health. 2006;30(2):151-156.
Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA. Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet. 2007;98(3):237-243.
Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol. 2010;202(4):353.e1-353.e6.
Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449.e1-449.e7.
Mehrabadi A, Hutcheon JA, Lee L, Kramer MS, Liston RM, Joseph KS. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective cohort study. BJOG. 2013;120(7):853-862.
Hirai AH, Owens PL, Reid LD, Vladutiu CJ, Main EK. Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019. JAMA Netw Open. 2022;5(7):e2222966.
Hesselman S, Lampa E, Wikman A, Törn AE, Högberg U, Wikström AK, et al. Time matters- Swedish cohort study of labor duration and risk of uterine rupture. Acta Obstet Gynecol Scand. 2021;100(10):1902-1909.
Guglielminotti J, Landau R, Li G. Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries. Anesthesiology. 2019;130(6):912-922.
Kuklina EV, Goodman DA. Severe maternal or near miss morbidity: implications for public health surveillance and clinical audit. Clin Obstet Gynecol. 2018;61(2):307-318.
Khashan AS, Evans M, Kublickas M, McCarthy FP, Kenny LC, Stenvinkel P, et al. Preeclampsia and risk of end stage kidney disease: a Swedish nationwide cohort study. PLoS Med. 2019;16(7):e1002875.
Hall DR, Conti-Ramsden F. Acute kidney injury in pregnancy including renal disease diagnosed in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2019;57:47-59.
Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Magee LA, Kramer MS, et al. Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada: population based retrospective cohort study. BMJ. 2014;349:g4731.
Hameed AB, Lawton ES, McCain CL, Morton CH, Mitchell C, Main EK, et al. Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. Am J Obstet Gynecol. 2015;213(3):379.e1-379.e10.
Liu S, Chan W-S, Ray JG, Kramer MS, Joseph KS. Stroke and cerebrovascular disease in pregnancy. Stroke. 2019;50(1):13-20.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546-1554.
Kendle AM, Salemi JL, Tanner JP, Louis JM. Delivery-associated sepsis: trends in prevalence and mortality. Am J Obstet Gynecol. 2019;220(4):391.e1-391.e16, 391.
Rhee C, Klompas M. Sepsis trends: increasing incidence and decreasing mortality, or changing denominator? J Thorac Dis. 2020;12(Suppl 1):S89-S100.
Wilhelms SB, Huss FR, Granath G, Sjöberg F. Assessment of incidence of severe sepsis in Sweden using different ways of abstracting international classification of diseases codes: difficulties with methods and interpretation of results. Crit Care Med. 2010;38(6):1442-1449.
Pregnancy-related deaths: data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Available from: https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html. Accessed 16 Oct 2022.