Preventability Review of Severe Maternal Morbidity

Severe maternal morbidity (SMM) is defined as life-threatening complications in pregnancy, or within 42 days of the termination of the pregnancy. The rate of SMM is rising globally, and minorities have higher rates; in high-resource countries, the reported prevalence is reported as 3.8 to 13.8 per 1000 deliveries. The researchers sought to establish the incidence and ethnically specific rates of SMM in New Zealand to see how preventable it is. The researcher performed a retrospective cohort study of pregnant or postpartum women in an intensive care unit or highdependency unit between August 2013 and January 2015. The primary outcomes were SMM rates and assessment of potential preventability, defined as provider, system, or patient action that may have contributed to progression to more severe morbidity and assessed by a multidisciplinary review team. Two hundred twenty-one clinicians were recruited from New Zealand, and 550 SMMcases were identified as eligible for the study. Ethnic group-specific and total SMMincidence was calculated using the cases divided by the total number of New Zealand deliveries over the same period. Deliveries were counted as any that resulted in live-born babies at any gestation or stillborn babies (20 weeks' gestation or later or with a birth weight >= 400 g). The incidence of SMMin women in New Zealand over this period was 6.2 per 1000 deliveries, with higher rates in women of Pacific Island (relative risk [RR], 2.25; 95% confidence interval [CI], 1.76-2.86), Indian (RR, 1.55; 95% CI, 1.05-2.28), and other Asian race/ethnicity (RR, 1.77; 95% CI, 1.37-2.29) as compared with European women. Women with SMM were also more likely to be older and smokers, have a bodymass index of less than 20 kg/m2 or greater than 29 kg/m(2), and have 4 ormore deliveries. They were also more likely to be in the lowest socioeconomic group. Themost common causes of SMMweremajor blood loss (39.4%), preeclampsia-associated conditions (23.3%), and severe sepsis (14.1%); preventability for the 3 factors was 30.9%, 34.3%, and 56%, respectively. In multidisciplinary review, only 36.4% of SMM cases were managed appropriately. The researchers found that just over one-third of SMMcases were preventable, with this rate due to poor provider care and higher preventability rates in minority women. The researchers see an opportunity to improve prevention of SMM by multi-disciplinary training and education and improving maternity care through audit, feedback, and/or system changes.