European Journal of Obstetrics & Gynecology and Reproductive Biology
Cohort study of near-miss maternal mortality and subsequent reproductive outcome
Introduction
Maternal death is now an uncommon event in developed countries [1], [2], [3] and it has been suggested that an evaluation of near-miss mortality cases may reflect more accurately on standards of maternity care [4], [5]. Near-miss mortality is difficult to define, but can be more objectively represented by women requiring transfer to an intensive care unit (ICU). Some centres, particularly in North America, have introduced obstetric ICUs or high dependency areas attached to the delivery suite [6], [7], [8]. The admission criteria to these units differ from those for admission to a medical or surgical ICU and make comparisons of outcome difficult. In the United Kingdom, critically ill obstetric patients are usually managed on the delivery suite in the first instance and are then transferred to an ICU where intensive care can be initiated. These women represent the severe end of the spectrum of near-miss maternal mortality. There has been little consideration to date of the longer-term effects on women experiencing near-miss maternal mortality, particularly in terms of subsequent fertility potential and reproductive outcome. We have undertaken a 12 year review of obstetric admissions to our ICU, CCU and neurosurgical ICU, and compare our experience with published data from other units. We report the maternal morbidity and mortality, perinatal mortality and subsequent reproductive outcome associated with these pregnancies.
Section snippets
Methods
St. Michael’s Hospital is a University teaching hospital which delivers approximately 5000 women each year. Women are also admitted in early pregnancy to the gynaecology wards and this review includes abortion and ectopic pregnancy. Patients who encounter severe complications in pregnancy are managed in the first instance on the delivery suite where incubation, ventilation, central venous pressure and arterial lines can be established but critically ill patients need to be transferred to the
Results
Of the 51,756 women delivered in the 12 year study period, 50 required transfer for intensive care (0.97/1000). One woman was transferred to the neurosurgical unit, 2 were transferred to CCU and the remaining 47 were transferred to the ICU. The intensive care admission rate, maternal mortality and perinatal mortality for the study population are compared to the results for other centres in Table 1.
The maternal age distribution was similar to the hospital population with 37 women (74%) aged
Discussion
The indications for intensive care described in this study correspond closely to the ICU admissions reported in the confidential enquiries into maternal deaths [1], suggesting that this is an appropriate group of patients to study in terms of near-miss maternal mortality. Hypertensive disease, haemorrhage, maternal cardiac disease and sepsis account for the majority of admissions and this finding is consistent across many centres World-wide [9], [10], [11], [12], [13], [14], [15], [16], [17],
Acknowledgements
The authors wish to thank Ms. Eleanor Ferris for her help in identifying information from the maternity database and in retrieving case records.
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