Premium
Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008–2013: a retrospective cohort
Author(s) -
Lipkind HS,
Zuckerwise LC,
Turner EB,
Collins JJ,
Campbell KH,
Reddy UM,
Illuzi JL,
Merriam AA
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15818
Subject(s) - medicine , retrospective cohort study , cohort , pregnancy , pediatrics , emergency medicine , database , surgery , genetics , biology , computer science
Objective This study utilized the Dr. Foster Global Comparators database to identify pregnancy complications and associated risk factors that led to severe maternal morbidity during delivery hospitalisations in large university hospitals based in the USA, Australia, and England. Design Retrospective cohort. Setting Births in the USA, England and Australia from 2008 to 2013. Sample Data from delivery hospitalisations between 2008 and 2013 were examined using the Dr. Foster Global Comparators database. Methods We identified delivery hospitalisations with life‐threatening diagnoses or use of life‐saving procedures, using algorithms for severe maternal morbidity from the Center for Disease Control. Frequency of severe maternal morbidity was calculated for each country. Main outcome measures Multivariable analysis was used to examine the association between morbidity and socio‐demographic and clinical characteristics within each country. Chi‐square tests assessed differences in covariates between countries. Results From 2008 to 2013, there were 516 781 deliveries from a total of 18 hospitals: 24.5% from the USA, 57.0% from England and 18.4% from Australia. Overall severe maternal morbidity rate was 8.2 per 1000 deliveries: 15.6 in the USA, 5.0 in England, and 8.2 in Australia. The most common codes identifying severe morbidity included transfusion, disseminated intravascular coagulation, acute renal failure, cardiac events/procedures, ventilation, hysterectomy, and eclampsia. Advanced maternal age, hypertension, diabetes, and substance abuse were associated with severe maternal morbidity in all three countries. Conclusion Rates of severe maternal morbidity differed by country. Identification of geographical, socio‐demographic, and clinical differences can help target modifications of practice and potentially reduce severe maternal morbidity. Tweetable abstract Rates of severe maternal morbidity vary, but risk factors associated with adverse outcomes are similar in developed countries.