Severe Maternal Morbidity May Be Rare, but Impact Is Large

SALT LAKE CITY — For every 1,000 deliveries in the United States between 1991 and 2000, 4.6 women experienced severe morbidity, William M. Callaghan, M.D., said at the annual meeting of the Society for Pediatric and Perinatal Epidemiologic Research.

Even relatively uncommon complications of pregnancy will impact large numbers of women, and hospitals should know where to focus their attention, said Dr. Callaghan of the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta.

He used data from the National Hospital Discharge Survey to examine ICD-9 codes and identify women who likely had severe morbidity during or shortly after delivery. The severe morbidity rate was based on a 3-day hospital stay, which was above the median length of stay for a pregnancy.

On examination of approximately 318,000 records, it was found that nearly 1,500 women experienced severe morbidity. Of these, almost 17% had a code for eclampsia. Respiratory failure, sepsis, renal failure, and cardiac arrest were among other causes of severe morbidity. In addition, nearly half of the women received transfusions, although the transfusion may have been as little as one unit of blood, Dr. Callaghan noted.

Older women, black women, and women with other than private insurance had a higher incidence of morbidity than their counterparts, as did women who delivered later in the decade. The incidence of severe morbidity increased gradually during the last 4 years of the study, but the reason for this increase was unclear, Dr. Callaghan said. He suggested that hospitals should use discharge codes to monitor severe morbidity as a way to review what types of services are being used and how to improve them.

“Identification and review of women with severe morbidity has potential to provide insight into opportunities for prevention along the continuum of morbidity,” he said.