Pregnant women's deaths due to severe, life-threatening conditions during pregnancy can be prevented as the Link between severe maternal morbidities (SMM) and after pregnancy deaths have been found. The findings of this study are published in the JAMA Open Network journal.
The number of severe maternal morbidities (SMM) a pregnant woman has is highly linked to her risk of maternal death
, according to a new study by researchers at ICES and St. Michael's Hospital.
‘As a result of the study, scientists have suggested utilizing existing maternal early warning systems and protocols to identify the woman's clinical deterioration and then reduce maternal deaths
SMM is defined by potentially life-threatening conditions such as ICU admission, invasive ventilation, and cardiac conditions that develop during pregnancy.
The study looked at the data for more than 1.9 million hospital births in Ontario and found that the number of SMM conditions was strongly associated with maternal death up to 42 days postpartum. The researchers found that the number of SMM was exponentially associated with maternal death.
"Our findings show that some SMM are predictive of death, and in light of that we should be targeting preventable SMM, or limiting their progression using an early warning system, in order to reduce maternal deaths," says Dr. Joel Ray, lead author on the study and a researcher at ICES and the Li Ka Shing Knowledge Institute of St. Michael's Hospital.
The researchers found that women with one SMM were 20 times more likely to die than women who did not have an SMM and that risk grew to 102 times the risk with two SMM, and up to 2192 times higher the risk with six or more SMM
The findings show the most common SMM conditions were postpartum hemorrhage with blood transfusion, ICU admission, puerperal sepsis (bacterial infection), severe preeclampsia (high blood pressure) and the urgent need for hysterectomy
The researchers identified 181 maternal deaths among all 1,953,943 births - a rate of 9.3 per 100,000 births. Of the 181 deaths, 68 percent of the women who died had at least one SMM condition. Women who died tended to be older, first-time moms, of lower income and Afro-Caribbean origin, with a multi-fetal pregnancy, pre-existing diabetes, high blood pressure, and kidney disease
"Despite improved family planning and obstetric care, maternal deaths have remained stable in Canada, and as many as half of those are thought to be preventable. Our findings illustrate the value of utilizing existing maternal early warning systems and protocols to identify a woman's clinical deterioration in order to reduce maternal deaths
," adds Ray.