Morbidity;Perinatal, Pregnancy Complications, Pregnancy Related
Conditions
Keywords
severe maternal morbidity, postpartum period, hospital readmission
Brief summary
For every case of maternal death, many more women experience life-threatening complications during pregnancy and childbirth. Yet, severe maternal morbidity (SMM) cases are often overlooked post-delivery. Women have reported that roughly 15% of SMM cases first occurred in the six weeks following delivery. The underlying factors associated with these morbidities are likely different than those occurring antenatally and at the time of delivery. Further research is required to elucidate the exact burden of SMM in the postpartum period in British Columbia (BC).
Detailed description
The ratio of maternal morbidity to maternal mortality is increasing globally (Geller 2018). In high-income countries, the World Health Organization (WHO) recommends routinely surveilling SMM to assess maternal health and quality of care (Geller 2018). To our knowledge, this is the first study conducted among pregnancies in BC aiming to examine the cumulative incidence, timing, and factors associated with postpartum maternal morbidity and hospital readmissions. This is a retrospective cohort study will use data from the BC Perinatal Data Registry (BCPDR), which contains maternal, fetal and neonatal health information from 99% of all deliveries in BC. The primary outcome assessed will be the cumulative incidence of hospital readmissions and SMM events occurring after delivery discharge within the first six weeks (42 days) of delivery. Secondary outcomes will include SMM-diagnosis, the rate and timing of postpartum SMM and readmissions, and maternal characteristics associated with these events. A multinominal logistic regression model will examine the association between postpartum SMM or readmission and determinants.
Interventions
OTHERRetrospective database analysis
This study will review data provided by the BCPDR from April 1, 2008 to March 31, 2021.
Sponsors
Women's Health Research Institute of British Columbia
University of British Columbia
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
15 Years to 49 Years
Inclusion criteria
* Delivered in BC from April 1, 2008 to March 31, 2021 * Consented to data collected by the BCPDR
Exclusion criteria
• None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maternal hospital readmission | Up to six weeks post-delivery discharge | Cumulative incidence of women who get readmitted into the hospital after being discharged post-delivery |
| Severe maternal morbidity (SMM) event | Up to six weeks post-delivery discharge | Cumulative incidence of women who experience least one SMM event, defined as: severe pre-eclampsia, HELLP, eclampsia; severe haemorrhage; maternal ICU admission; surgical complications; hysterectomy; sepsis; embolism, shock, DIC; assisted ventilation; cardiac conditions; acute renal failure; several uterine rupture; cerebrovascular accidents; and other types of maternal morbidity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SMM type | Up to six weeks postpartum | Type of SMM event experienced |
| Rate of hospital readmission and SMM events | Up to six weeks postpartum | Frequency of women who get readmitted to the hospital after discharge and/or experienced at least one SMM event |
| Timing of hospital readmission and SMM events | Up to six weeks postpartum | Specific time frames for women who get readmitted to the hospital after discharge and/or experienced at least one SMM event |
| Maternal characteristics | Up to six weeks postpartum | Characteristics associated with hospital readmission and SMM events after delivery discharge, such as age, race, geographic location, fetal outcome, mode of delivery and pre-existing maternal comorbidities (hypertension, diabetes, and mental health conditions). |
Outcome results
None listed