The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery

Colmorn, Lotte Berdiin; Petersen, Kathrine Birch; Jakobsson, Maija; Lindqvist, Pelle G.; Klungsøyr, Kari; Källén, Karin; Bjarnadóttir, Ragnheiður I.; Tapper, Anna‐Maija; Børdahl, Per E.; Gottvall, Karin; Thurn, Lars; Gissler, Mika; Krebs, Lone; Langhoff‐Roos, Jens

doi:10.1111/aogs.12639

Cited by 59 publications

(79 citation statements)

References 24 publications

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“…This is considered feasible, since has already been observed in developed countries a reduction in the cases of hypertensive disorders (and they are not the main maternal condition associated with NM, but the hemorrhagic disorders) (16) . Of the MNM cases identified, the majority were in the age group of 20 to 35 years, as well as the AFNO -which differs from other studies conducted in Brazil and Nordic countries, in which MNM was associated with the maternal age of 35 years or more (9,17) . In this study, there was prevalence of NM cases related to parity of primigravidae, which may be related to the fact that hypertensive disorders are more frequent in the first gestation or to divergences in relation to parity in different countries.…”

Section: Discussioncontrasting

confidence: 77%

Óbitos fetais e neonatais de filhos de pacientes classificadas com near miss

et al. 2017

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How to cite this article: Nardello DM, Guimarães AMDN, Barreto IDC, Gurgel RQ, Ribeiro ERO, Gois CFL. ABSTRACT Objective: identify the epidemiological aspects of early fetal and neonatal deaths in children of patients classifi ed with near miss and the factors associated with this outcome. Method: a cross-sectional study of 79 women identifi ed with near miss and their newborns. The variables were analyzed using Fisher's exact test. Risk factors were estimated based on unadjusted and adjusted odds ratios, and by means of multiple correspondence analysis, with signifi cance for p <0.05. Results: hypertensive disorders totaled 40.5%; Of these, 58.3% had adverse fetal and neonatal outcome. The newborns admitted to the Neonatal Intensive Care Unit proved to be signifi cant for the outcome (70.8%), gestational age <32 weeks (41.6%), birth weight <2500 (66.7%), neonatal asphyxia (50%) and early respiratory discomfort (72.2%). Conclusion: prematurity, neonatal asphyxia, and early respiratory distress were signifi cant characteristics for the outcome among newborns. Descriptors: Pregnancy Complications; Near Miss; Fetal Death; Perinatal Death; Epidemiology. RESUMO Objetivo: identifi car os aspectos epidemiológicos dos óbitos fetais e neonatais precoces em fi lhos de pacientes classifi cadas com near miss e os fatores associados a este desfecho. Método: estudo transversal realizado com 79 mulheres identifi cadas com near miss e seus recém-nascidos. As variáveis foram analisadas utilizando-se o teste Exato de Fisher. Os fatores de risco foram estimados com base nas razões de chances não ajustadas e ajustadas, e por meio de análise de correspondência múltipla, com signifi cância para p < 0,05. Resultados: as desordens hipertensivas totalizaram 40,5%; destas, 58,3% tiveram desfecho fetal e neonatal adverso. Mostraram-se signifi cantes para o desfecho os recém-nascidos admitidos na Unidade Terapia Intensiva Neonatal (70,8%), idade gestacional < 32 semanas (41,6%), peso ao nascer < 2500 (66,7%), asfi xia neonatal (50%) e desconforto respiratório precoce (72,2%). Conclusão: prematuridade, asfi xia neonatal e desconforto respiratório precoce constituíram características signifi cantes para o desfecho entre os recém-nascidos. Descritores: Complicações na Gravidez; Near Miss; Morte Fetal; Morte Perinatal; Epidemiologia. RESUMEN Objetivo: identifi car los aspectos epidemiológicos de los óbitos fetales y neonatales precoces en hijos de pacientes clasifi cados con near miss y los factores asociados a este desenlace. Método: estudio transversal realizado con 79 mujeres identifi cadas con near miss y sus recién nacidos. Las variables fueron analizadas utilizando la prueba Exacta de Fisher. Los factores de riesgo fueron estimados con base en las razones de posibilidades no ajustadas y ajustadas, y por intermedio de análisis de correspondencia múltiple, con signifi cación para p < 0,05. Resultados: los desórdenes hipertensivos totalizaron el 40,5%; de los cuales el 58,3% tuvieron desenlace fetal y neonatal adverso. Se han mostrado signi...

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Section: Discussioncontrasting

confidence: 77%

Óbitos fetais e neonatais de filhos de pacientes classificadas com near miss

et al. 2017

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“…At the time this research was conducted, few comparable international studies existed because data collection was ongoing in many INOSS participating countries, the notable exception being the study completed from the Netherlands. 198 Comparison of the results of these studies with those recently published using similar methodology, such as those from the Nordic countries, 235,236 may provide further information to guide optimal management. l Obstetric interventions, such as induction of labour and caesarean delivery, are associated with a number of severe morbidities and research to investigate methods to reduce intervention rates without increasing other adverse outcomes is important as a route to prevention of near-miss morbidity.…”

Section: Implications For Future Researchmentioning

confidence: 97%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…The indication for PH also changed, with cases increasingly being attributed to morbidly adherent placenta (MAP), a finding in keeping with large international reviews. 12,14,15,22,23 In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend In collaboration with the 20 Irish maternity units we carried out a clinical audit of severe maternity morbidity for the three-year period 2011-2013, having adapted the methods of the Scottish Confidential Audit. 25 PH, defined as hysterectomy performed following delivery of a pregnancy or at any time during the puerperal period, was a reportable morbidity in the Irish audit and required the completion of a brief notification form which recorded indication for PH and core maternal and perinatal variables.…”

mentioning

confidence: 99%