Best Practice & Research Clinical Obstetrics & Gynaecology
1Epidemiology of obstetric critical care
Section snippets
Definitions
Maternal obstetric morbidity may be defined as morbidity from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.11 Mantel et al12 defined severe maternal morbidity as ‘a very ill pregnant or recently delivered woman who would have died had it not been but luck and good care was on her side’. They also use the term ‘severe acute maternal morbidity’.12
The term ‘near-miss’ has been borrowed from the aviation industry to describe
Prevalence
The rates of severe maternal morbidity tend to parallel maternal death rates. Prevalence also depends on the definition of morbidity. In developed countries, morbidity rates range from 0.05 to 1.7%.13, 14 In countries with low resources, prevalence ranges from 0.6 to 8.5%.15, 16 Say et al.17, in a systematic review of 30 studies in 2004, found that within the different definitions of morbidity, the prevalence varied between 0.8% and 8.2% for disease-specific criteria, 0.4% and 1.1% for
Classification
Many different classifications of severe maternal morbidity have arisen in the last 15 years and these will be considered below.
Severe morbidity audit in low-resource settings
A number of audits included in Table 1, Table 2, Table 3, Table 4 are from low-resource settings. In general, the main causes of morbidity are the same, haemorrhage and hypertensive disorders, but the death to morbidity ratio tends to be lower compared with developed countries. Two studies from Nigeria54 and West Africa55 showed that in addition to haemorrhage and hypertension, obstructed labour and sepsis remain significant risks to the mother. In the Nigerian study, there were 13 deaths out
Trends
There is reason to believe that severe maternal morbidity may increase in developed countries.56 This is likely because of the changing demographics of pregnant women in developed countries with increasing maternal age, increasing caesarean section rates and obesity.57, 58 The most recent UK Confidential Enquiry into Maternal Deaths (2003–2005) implicated obesity in almost half of the deaths.59 In addition, assisted reproductive technology has increased the number of multiple pregnancies,
Preparedness for obstetric critical care
Obstetrics has always lent itself to audit and measurement. The main causes of maternal mortality and morbidity are known. National, regional and hospital audits will help delineate the main local threats, but in almost all studies of severe maternal morbidity, whether they be based on ICU admissions, organ system dysfunction or clinically defined morbidities, be they in developed or developing countries, the dominant obstetric causes are haemorrhage and severe pre-eclampsia/eclampsia.
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Epidemiology of obstetric critical illness
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2016, International Journal of Gynecology and ObstetricsSedation in critically-ill obstetric patients
2015, International Journal of Obstetric Anesthesia