Objective: To assess prevalence and causes of severe acute maternal morbidity ( SAMM) cases and evaluate their impact on feto-maternal wellbeing and on facility resources. Study Design: Observational study adopting management based criteria in a tertiary care public institution during a 7-year period. Criteria adopted were: intensive care unit admission, blood transfusion ≥ 4 units, emergency peripartum hysterectomy and arterial embolization at any time during pregnancy.Results: A total of 113 cases were identified, giving an incidence of 8.7 near misses per 1000 deliveries, out of a parturient population of 12,933 women. Most SAMM cases (98.2%) were detected through a combination of two criteria, ICU admission and blood transfusion. Commonest severe obstetric morbidities were major obstetric haemorrhage (50.4%) and hypertensive disorders (25.7%). Sub-Saharian African origin (OR 1.95, 95% CI 1.02-3.73), pre-term birth (OR 6.45, 95% CI 4.16- 10.01), Caesarean section (OR 6.82, 95% CI 3.851), Caesarean section (OR 6.82, 9 CI 1.02nest severe obstetric morbidities were major obstetric haemorrha33 women (29.2%), with emergency peripartum hysterectomy in 13 (11.5%). Stillbirth rate was 7.7% and maternal mortality to morbility ratio was 2:113. Maternal near miss events led to an average blood consumption per woman 6.3±11.5 units and a mean hospital stay 9.32±5.6 days, significantly longer (p < 0.001) than the average duration of post-delivery care. Conclusions: An integrated intervention-based approach effectively identified severe acute maternal morbidity cases, underlying causes and associated risk factors. Continuous auditing within the obstetric team should improve prevention and treatment of obstetric morbidities, thus reducing feto-maternal adverse effects and hospital expenditures.
Obstetric near miss in a tertiary care hospital of northern Italy: impact on feto-maternal health
Zanconato G.;Cavaliere E.;IACOVELLA, Carlotta;Schweiger V.;CIPRIANI, SONIA;Franchi M.
2012-01-01
Abstract
Objective: To assess prevalence and causes of severe acute maternal morbidity ( SAMM) cases and evaluate their impact on feto-maternal wellbeing and on facility resources. Study Design: Observational study adopting management based criteria in a tertiary care public institution during a 7-year period. Criteria adopted were: intensive care unit admission, blood transfusion ≥ 4 units, emergency peripartum hysterectomy and arterial embolization at any time during pregnancy.Results: A total of 113 cases were identified, giving an incidence of 8.7 near misses per 1000 deliveries, out of a parturient population of 12,933 women. Most SAMM cases (98.2%) were detected through a combination of two criteria, ICU admission and blood transfusion. Commonest severe obstetric morbidities were major obstetric haemorrhage (50.4%) and hypertensive disorders (25.7%). Sub-Saharian African origin (OR 1.95, 95% CI 1.02-3.73), pre-term birth (OR 6.45, 95% CI 4.16- 10.01), Caesarean section (OR 6.82, 95% CI 3.851), Caesarean section (OR 6.82, 9 CI 1.02nest severe obstetric morbidities were major obstetric haemorrha33 women (29.2%), with emergency peripartum hysterectomy in 13 (11.5%). Stillbirth rate was 7.7% and maternal mortality to morbility ratio was 2:113. Maternal near miss events led to an average blood consumption per woman 6.3±11.5 units and a mean hospital stay 9.32±5.6 days, significantly longer (p < 0.001) than the average duration of post-delivery care. Conclusions: An integrated intervention-based approach effectively identified severe acute maternal morbidity cases, underlying causes and associated risk factors. Continuous auditing within the obstetric team should improve prevention and treatment of obstetric morbidities, thus reducing feto-maternal adverse effects and hospital expenditures.
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