Frequency of and Factors Associated with Severe Maternal Morbidity

Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW, Thorp JM Jr, Leveno KJ, Caritis SN, Iams JD, Tita AT, Saade G, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Van Dorsten JP; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol. 2014 Apr;123(4):804-10. doi: 10.1097/AOG.0000000000000173. PubMed PMID: 24785608; PubMed Central PMCID: PMC4116103

Objective
To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.

Methods
This was a secondary analysis of a National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (> 3 units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity, these were used to develop a prediction model for severe maternal morbidity.

Results
Among 115,502 women who delivered during the study period, 332 (2.9 per thousand births, 95% CI 2.6 – 3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver-operating characteristic curve of 0.80.

Conclusion
Severe maternal morbidity occurs in approximately 2.9 per 1000 births, is most commonly due to postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics.

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