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.

Perinatal outcome of severe obstetric complications: findings of a 10-year hospital-based surveillance study in Italy

Zanconato, Giovanni;Cavaliere, Elena;Mariotto, Olga;Zatti, Nicoletta
2019-01-01

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.
2019
intensive care unit; maternal near miss; organ dysfunction; severe obstetric morbidity
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1009723
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