Risk Factors for Progression from Severe Maternal Morbidity to Death: A National Cohort Study

Gilles Kayem,Marian Knight,Shona Golightly,Peter Brocklehurst,Jennifer Kurinczuk,Gwyneth Lewis,Philippa Middleton

doi:10.1371/journal.pone.0029077

Gilles Kayem, Marian Knight + Show 5 more

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https://doi.org/10.1371/journal.pone.0029077

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Journal: PloS one	Publication Date: Dec 28, 2011
Citations: 83	License type: CC BY 4.0

Affiliation: University of Oxford, Oxford Policy Management

Abstract

BackgroundWomen continue to die unnecessarily during or after pregnancy in the developed world. The aim of this analysis was to compare women with severe maternal morbidities who survived with those who died, to quantify the risk associated with identified factors to inform policy and practice to improve survival.Methods and FindingsWe conducted a national cohort analysis using data from two sources obtained between 2003 and 2009: the Centre for Maternal and Child Enquiries maternal deaths database and the United Kingdom Obstetric Surveillance System database. Included women had eclampsia, antenatal pulmonary embolism, amniotic fluid embolism, acute fatty liver of pregnancy or antenatal stroke. These conditions were chosen as major causes of maternal mortality and morbidity about which data were available through both sources, and include 42% of direct maternal deaths over the study period. Rates, risk ratios, crude and adjusted odd ratios were used to investigate risks factors for maternal death. Multiple imputation and sensitivity analysis were used to handle missing data.We identified 476 women who survived and 100 women who died. Maternal death was associated with older age (35+ years aOR 2.36, 95%CI 1.22–4.56), black ethnicity (aOR 2.38, 95%CI 1.15–4.92), and unemployed, routine or manual occupation (aOR 2.19, 95%CI 1.03–4.68). An association was also observed with obesity (BMI≥30 kg/m2 aOR 2.73, 95%CI 1.15–6.46).ConclusionsOngoing high quality national surveillance programmes have an important place in addressing challenges in maternal health and care. There is a place for action to reverse the rising trends in maternal age at childbirth, and to reduce the burden of obesity in pregnancy, as well as ongoing recognition of the impact of older maternal age on the risks of pregnancy. Development and evaluation of services to mitigate the risk of dying associated with black ethnicity and lower socioeconomic status is also essential.

Highlights

Reducing maternal mortality has been recognised as an important challenge facing all governments and international agencies [1]
One hundred maternal deaths from one of the five specific causes under investigation were identified from the Centre for Maternal and Child Enquiries (CMACE) database to have occurred between 2003 and 2008
The ratio of survivors to deaths was lowest for amniotic fluid embolism (AFE), stroke and pulmonary embolism (PE): for every two women with an AFE who die, five have an AFE and survive; for every woman dying of a stroke, three survive; and for every woman dying of a PE 19 survive

Summary

Introduction

Reducing maternal mortality has been recognised as an important challenge facing all governments and international agencies [1]. The greatest challenges in tackling maternal mortality face the developing world, women continue to die unnecessarily during or after pregnancy in the developed world [4,5]. Women continue to die unnecessarily during or after pregnancy in the developed world The aim of this analysis was to compare women with severe maternal morbidities who survived with those who died, to quantify the risk associated with identified factors to inform policy and practice to improve survival

Methods

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Conclusion