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Examining adverse fetal/neonatal outcomes associated with severe maternal morbidity
Author(s) -
Lawton Beverley,
Filoche Sara,
MacDonald Evelyn Jane,
Stanley James,
Meeks Maggie,
Stone Peter,
Storey Francesca,
Geller Stacie E.
Publication year - 2020
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13163
Subject(s) - medicine , neonatal intensive care unit , apgar score , obstetrics , fetus , neonatal encephalopathy , pregnancy , retrospective cohort study , adverse effect , pediatrics , encephalopathy , biology , genetics
Background While there is a global focus on severe maternal morbidity (SMM), less is known about the impact of SMM on fetal and neonatal outcomes. Aims To examine fetal/neonatal outcomes associated with SMM. Materials and Methods A national New Zealand (NZ) retrospective cohort study describing fetal/neonatal outcomes of all women with SMM admitted to a NZ Intensive Care Unit (ICU) or High Dependency Unit (HDU) in 2014. Adverse fetal/neonatal outcomes were defined as one or more of the following: fetal or early neonatal death, hypoxic ischaemic encephalopathy, Apgar score less than seven at five minutes, admission to Neonatal Intensive Care Unit or Special Care Baby Unit. Results There were 400 women with SMM admitted to NZ ICU/HDU units in 2014, and 395 (98.8%) had complete birth/pregnancy outcome information. Of these, 49.4% (195/395) were associated with an adverse fetal/neonatal outcome. Indigenous Māori women had a 30% higher rate of adverse fetal/neonatal outcome compared to NZ European women (63.7% and 48.9% respectively; relative risk = 1.30, 95% CI 1.04–1.64). Pre‐eclampsia was associated with an adverse fetal/neonatal outcome in 67% (81/120). Perinatal‐related mortality rate was 53.1 per 1000 total births compared to NZ perinatal mortality of 11.2 per 1000 total births for 2014. Conclusion SMM events are associated with high rates of adverse fetal/neonatal outcomes with a higher burden of adverse events for Māori. Further research is needed to explore opportunities in maternal and neonatal care pathways to improve fetal/neonatal outcomes and address inequities.