Frequency of and factors associated with severe maternal morbidity

William A. Grobman, Jennifer L. Bailit, Madeline Murguia Rice, Ronald J. Wapner, Uma M. Reddy, Michael W. Varner, John M. Thorp, Kenneth J. Leveno, Steve N. Caritis, Jay D. Iams, Alan T. Tita, George Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa, J. Peter Van Dorsten

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence. 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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)804-810
Number of pages7
JournalObstetrics and Gynecology
Volume123
Issue number4
DOIs
StatePublished - Apr 1 2014

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Mothers
Morbidity
Postpartum Hemorrhage
National Institute of Child Health and Human Development (U.S.)
Parturition
Erythrocyte Transfusion
Intubation
ROC Curve
Intensive Care Units
Medicine
Newborn Infant
Confidence Intervals

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Grobman, W. A., Bailit, J. L., Rice, M. M., Wapner, R. J., Reddy, U. M., Varner, M. W., ... Van Dorsten, J. P. (2014). Frequency of and factors associated with severe maternal morbidity. Obstetrics and Gynecology, 123(4), 804-810. https://doi.org/10.1097/AOG.0000000000000173

Frequency of and factors associated with severe maternal morbidity. / Grobman, William A.; Bailit, Jennifer L.; Rice, Madeline Murguia; Wapner, Ronald J.; Reddy, Uma M.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Caritis, Steve N.; Iams, Jay D.; Tita, Alan T.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.; Van Dorsten, J. Peter.

In: Obstetrics and Gynecology, Vol. 123, No. 4, 01.04.2014, p. 804-810.

Research output: Contribution to journalArticle

Grobman, WA, Bailit, JL, Rice, MM, Wapner, RJ, Reddy, UM, Varner, MW, Thorp, JM, Leveno, KJ, Caritis, SN, Iams, JD, Tita, AT, Saade, G, Sorokin, Y, Rouse, DJ, Blackwell, SC, Tolosa, JE & Van Dorsten, JP 2014, 'Frequency of and factors associated with severe maternal morbidity', Obstetrics and Gynecology, vol. 123, no. 4, pp. 804-810. https://doi.org/10.1097/AOG.0000000000000173
Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW et al. Frequency of and factors associated with severe maternal morbidity. Obstetrics and Gynecology. 2014 Apr 1;123(4):804-810. https://doi.org/10.1097/AOG.0000000000000173
Grobman, William A. ; Bailit, Jennifer L. ; Rice, Madeline Murguia ; Wapner, Ronald J. ; Reddy, Uma M. ; Varner, Michael W. ; Thorp, John M. ; Leveno, Kenneth J. ; Caritis, Steve N. ; Iams, Jay D. ; Tita, Alan T. ; Saade, George ; Sorokin, Yoram ; Rouse, Dwight J. ; Blackwell, Sean C. ; Tolosa, Jorge E. ; Van Dorsten, J. Peter. / Frequency of and factors associated with severe maternal morbidity. In: Obstetrics and Gynecology. 2014 ; Vol. 123, No. 4. pp. 804-810.
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AU - Bailit, Jennifer L.

AU - Rice, Madeline Murguia

AU - Wapner, Ronald J.

AU - Reddy, Uma M.

AU - Varner, Michael W.

AU - Thorp, John M.

AU - Leveno, Kenneth J.

AU - Caritis, Steve N.

AU - Iams, Jay D.

AU - Tita, Alan T.

AU - Saade, George

AU - Sorokin, Yoram

AU - Rouse, Dwight J.

AU - Blackwell, Sean C.

AU - Tolosa, Jorge E.

AU - Van Dorsten, J. Peter

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N2 - OBJECTIVE: To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence. 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. CONCLUSION: 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.

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