Abstract
Objective
To assess incidence and clinical patterns of severe maternal morbidities related to pregnancy. To determine associated feto-maternal outcomes and economic costs for the institution.
Methods
Observational study in a tertiary care Italian public hospital during a 10-year period. To identify severe obstetric complications, the following management-based criteria were adopted: need for intensive care unit admission, blood transfusion ≥5 units, emergency peripartum hysterectomy/laparotomy and arterial embolization. Impact of severe obstetric complications on facility resources was estimated considering length of hospital stay, need for additional surgery and transfusion.
Results
A total of 151 cases were identified, most frequent obstetric morbidities being major obstetric hemorrhage (50.3%) and hypertensive disorders (19.2%). Pre-term birth, caesarean section and sub-saharan African origin were factors significantly associated with severe morbidity. Maternal mortality and maternal mortality to morbidity ratios were 17 per 100,000 live births and 3:151, respectively. Stillbirth rate was 4.4%. Massive use of blood products and prolonged admissions concurred to increase hospital expenditures.
Conclusion
Institutional severe maternal morbidities may be effectively monitored by implementing a surveillance program and selecting a combination of management-based criteria which define the extremely morbid cases. Focusing on causes and risk factors associated with adverse obstetric situations has the potential to improve quality of care, prevent maternal life-threatening complications and perinatal mortality, reduce hospital expenditures.
Acknowledgment
The abstract of this paper was presented with interim findings at the 19th National Congress of the Italian Society of Perinatal Medicine (Società Italiana di Medicina Perinatale, SIMP) in Naples, January 19th −21st, 2017. The poster abstract was published in the J Pediatr Neonat Individual Med. 2017;6(1):e060125. doi: 10.7363/060125.
Ethics approval and consent to participate
All human subjects provided written informed consent; all medical records were anonymized and maintained with confidentiality. The study was a clinical practice evaluation and in lieu of a formal ethics committee, the principles of Helsinki Declaration were followed. The registered number was not requested.
Data sharing statement
The data that support the findings of this study are available on request from the corresponding author [GZ].
Author contributions
All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.