title: Severe acute maternal morbidity in a high-income developing multiethnic country.
abstract: With declining maternal mortality, the study of severe acute maternal morbidity (SAMM) provides an opportunity to measure the quality of maternal care and to identify ways to improve it. The objective was to study the epidemiology of severe acute maternal morbidity in a high income, rapidly developing, multiethnic country in the Middle East, and to determine the role of ethnicity in maternal morbidity. We included all births occurring in maternal units with more than 500 births a year over a 6 year period in Abu Dhabi emirate, the largest province of the United Arab Emirates. Data on SAMM was collected retrospectively for the first 3 years and prospectively for the later 3 years. A clinical criteria based approach was used to define SAMM. Over the 6 year period there were 122,705 deliveries, and a total of 926 cases of SAMM were identified. The SAMM to births ratio was 7.5/1,000 deliveries. The leading cause of maternal morbidity was hypertensive disorders (59.5 %) followed by hemorrhage (39.6 %). There were clear ethnic differences. Preeclampsia was significantly higher in women from the Indian sub-continent and hemorrhage was more prevalent in UAE women. We have shown that it is possible to use a clinical criteria based approach to study the epidemiology of SAMM. The leading contributors to SAMM were hypertensive disorders and hemorrhage with clear ethnic links supporting earlier reports of a complex interaction between ethnicity, socioeconomic status and maternal health.
authors.affiliation: Department Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates.
authors.forename: Saad
authors.initials: S
authors.lastname: Ghazal-Aswad
authors.forename: Padmanabhan
authors.initials: P
authors.lastname: Badrinath
authors.forename: Islam
authors.initials: I
authors.lastname: Sidky
authors.forename: Thikra Hassan
authors.initials: TH
authors.lastname: Safi
authors.forename: Husnia
authors.initials: H
authors.lastname: Gargash
authors.forename: Yousef
authors.initials: Y
authors.lastname: Abdul-Razak
authors.forename: Hisham
authors.initials: H
authors.lastname: Mirghani
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007182:Income; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality / Q000208:ethnology*; D008485:Medical Audit; D009017:Morbidity; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D011256:Pregnancy Outcome; D015995:Prevalence; D011446:Prospective Studies; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014479:United Arab Emirates / Q000453:epidemiology; D055815:Young Adult