title: Preventability of severe acute maternal morbidity.
abstract: OBJECTIVE
  We sought to assess potential preventability of severe acute maternal morbidity (SAMM) cases admitted to intensive-care units (ICUs) or high-dependency units (HDUs).
  
  
  METHODS
  Inclusion criteria were admissions to ICUs or HDUs of women who were pregnant or within 42 days of delivery in 4 District Health Board areas (accounting for a third of annual births in New Zealand) during a 17-month period. Cases were reviewed by external multidisciplinary panels using a validated model for assessing preventability.
  
  
  RESULTS
  In all, 98 SAMM cases were assessed; 38 (38.8%) cases were deemed potentially preventable, 36 (36.7%) not preventable but improvement in care was needed, and 24 (24.5%) not preventable. The most frequent preventable factors were clinician related: delay or failure in diagnosis or recognition of high-risk status (51%); and delay or inappropriate treatment (70%). The most common causes of preventable severe morbidity were blood loss and septicemia.
  
  
  CONCLUSIONS
  The majority of SAMM cases were potentially preventable or required improvement in care. Themes around substandard care related to delay in diagnosis and treatment for postpartum hemorrhage and septicemia. These findings can inform clinical educational programs and policies to improve maternal outcomes. This study has now been expanded to a national New Zealand audit of all SAMM cases admitted to an ICU/HDU.
authors: Women's Health Research Center, Department of Primary Care, University of Otago, Wellington, New Zealand. Electronic address: Bev.lawton@otago.ac.nz.
authors: Beverley
authors: B
authors: Lawton
authors: Women's Health Research Center, Department of Primary Care, University of Otago, Wellington, New Zealand.
authors: Evelyn Jane
authors: EJ
authors: MacDonald
authors: Women's Health Research Center, Department of Primary Care, University of Otago, Wellington, New Zealand.
authors: Selina Ann
authors: SA
authors: Brown
authors: Department of Anesthesia, Capital and Coast District Health Board, Wellington, New Zealand.
authors: Leona
authors: L
authors: Wilson
authors: Women's Health Research Center, Department of Primary Care, University of Otago, Wellington, New Zealand.
authors: James
authors: J
authors: Stanley
authors: Women's Health Service, Capital and Coast District Health Board, Wellington, New Zealand.
authors: John David
authors: JD
authors: Tait
authors: Department of Intensive Care, Capital and Coast District Health Board, Wellington, New Zealand.
authors: Richard Alan
authors: RA
authors: Dinsdale
authors: Women's Health Service, Capital and Coast District Health Board, Wellington, New Zealand.
authors: Carolyn Lee
authors: CL
authors: Coles
authors: Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL.
authors: Stacie E
authors: SE
authors: Geller
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008485:Medical Audit / Q000379:methods*; D009520:New Zealand / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: maternal morbidity; preventability