Frequency of and factors associated with severe maternal morbidity.
OBJECTIVE
To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.Supplemental Digital Content is Available in the Text.


METHODS
This was a secondary analysis of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (more than three units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity; these were used to develop a prediction model for severe maternal morbidity.


RESULTS
Among 115,502 women who delivered during the study period, 332 (2.9/1,000 births, 95% confidence interval 2.6-3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver operating characteristic curve of 0.80.


CONCLUSIONS
Severe maternal morbidity occurs in approximately 2.9 per 1,000 births, is most commonly the result of postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics.


METHODS
: II.
Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio, Columbia University, New York, New York, the University of Utah Health Sciences Center, Salt Lake City, Utah, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, the University of Texas Southwestern Medical Center, Dallas, Texas, the University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama, the University of Texas Medical Branch, Galveston, Texas, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, Oregon Health & Science University, Portland, Oregon, and the Medical University of South Carolina, Charleston, South Carolina; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
William A
WA
Grobman
Jennifer L
JL
Bailit
Madeline Murguia
MM
Rice
Ronald J
RJ
Wapner
Uma M
UM
Reddy
Michael W
MW
Varner
John M
JM
Thorp
Kenneth J
KJ
Leveno
Steve N
SN
Caritis
Jay D
JD
Iams
Alan T
AT
Tita
George
G
Saade
Yoram
Y
Sorokin
Dwight J
DJ
Rouse
Sean C
SC
Blackwell
Jorge E
JE
Tolosa
J Peter
JP
Van Dorsten
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D008428:Maternal Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012372:ROC Curve; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult