title: Severe maternal morbidity in a tertiary care centre of northern Italy: a 5-year review.
abstract: OBJECTIVE
  To assess prevalence and causes of severe acute maternal morbidity cases and evaluate their impact on feto-maternal wellbeing and on facility resources.
  
  
  METHODS
  Observational retrospective study adopting management-based criteria in a tertiary care public hospital during a 5-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 80 cases were identified, most of them (97.5%) through a combination of two criteria, ICU admission and blood transfusion. Commonest severe obstetric morbidities were major obstetric haemorrhage (48.8%) and hypertensive disorders (27.5%). Immigrant status (OR 1.68, 95% CI 1.03-2.7), pre-term birth (OR 4.15, 95% CI 2.5-6.8), Caesarean section (OR 7.74,95% CI 4.2-14.3) were factors significantly associated with SAMM cases. Major abdominal surgery was necessary in 26 women (32.5%), with emergency peripartum hysterectomy in 11 (13.5%). These events led to an average blood consumption per woman of 6.5 ± 12.8 units and a mean hospital stay of 8.9 ± 5.0 days, significantly longer (p < 0.001) than the average duration of post-delivery care. Maternal mortality to morbidity ratio was 1:80.
  
  
  CONCLUSIONS
  An integrated intervention-based approach proved to be effective in finding severe acute maternal morbidity cases. Information on underlying causes and associated risk factors may improve prevention and treatment of obstetric morbidities, thus reducing feto-maternal adverse effects and hospital expenditures.
authors.affiliation: University of Verona, Department of Life Science and Reproduction, Verona, Italy. giovanni.zanconato@univr.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zanconato
authors.forename: Elena
authors.initials: E
authors.lastname: Cavaliere
authors.forename: Carlotta
authors.initials: C
authors.lastname: Iacovella
authors.forename: Aurora
authors.initials: A
authors.lastname: Vassanelli
authors.forename: Vittorio
authors.initials: V
authors.lastname: Schweiger
authors.forename: Sonia
authors.initials: S
authors.lastname: Cipriani
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchi
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult