title: Contraception post severe maternal morbidity: a retrospective audit.
abstract: BACKGROUND
  Rapid repeat pregnancy is associated with maternal and neonatal morbidity. Effective postpartum contraception should be offered to all women, including those who experience severe acute maternal morbidity (SAMM), but little is known about contraceptive initiation in this group. Severe preexisting comorbidities with high pregnancy-related mortality risks are an important subset. This study examines contraceptive advice and prescription for SAMM cases with or without severe preexisting comorbidity.
  
  
  METHODS
  A retrospective audit of 98 SAMM cases was conducted to identify contraceptive advice and prescription preconception (for women with severe preexisting comorbidities), antenatally and/or postnatally. This is a secondary analysis of SAMM cases audited for preventability of SAMM in four District Health Board areas (covering a third of annual births in New Zealand) during a 17-month period. Case notes and preventability audit were manually searched.
  
  
  RESULTS
  Of 98 SAMM cases reviewed, 84 (85.7%) left hospital without a contraception prescription. Of 14 with contraception documented on discharge from hospital, 4 (4.1%) had peripartum hysterectomy, 3 (3.1%) had tubal ligation at cesarean section, 1 partner had a vasectomy booked, 1 (1%) had a Jadelle© contraceptive implant inserted and 5 (5.1%) had condom prescriptions. Of 7 women with severe preexisting comorbidity, 4 had preconception advice against conceiving. All 7 left hospital postpartum without contraceptive prescription.
  
  
  CONCLUSIONS
  These results indicate substandard contraceptive care for women experiencing SAMM. All those with severe preexisting comorbidities left hospital postpartum without receiving contraception. Improvement in immediate postpartum contraceptive care for these women is advocated to avoid future morbidity and mortality.
authors.affiliation: Women's Health Research Centre, Department of Primary Care, University of Otago, PO Box 7343, Wellington 6021, New Zealand. Electronic address: ej.macdonald@otago.ac.nz.
authors.forename: E Jane
authors.initials: EJ
authors.lastname: MacDonald
authors.affiliation: Women's Health Research Centre, Department of Primary Care, University of Otago, PO Box 7343, Wellington 6021, New Zealand. Electronic address: bev.lawton@otago.ac.nz.
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawton
authors.affiliation: Department of Obstetrics and Gynecology, University of Illinois, Chicago, IL 60612, USA. Electronic address: SGeller@uic.edu.
authors.forename: Stacie E
authors.initials: SE
authors.lastname: Geller
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception; D005260:Female; D006801:Humans; D008485:Medical Audit; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D055815:Young Adult
keywords: Long acting reversible contraception; Maternal comorbidity; Postpartum contraception; Severe maternal morbidity