Background Death is the last point on the spectrum of adverse pregnancy events. Nevertheless, it is essential to know the full extent to which women’s health is affected during or shortly after pregnancy, and to identify their main causes of illness. In developed countries, most maternal deaths are currently avoidable and severe maternal morbidities (SMMs) have been recognised as important indicators of the broader issues affecting maternal health. Therefore, this study aims to quantify the magnitude of specific maternal morbidities in Ireland.
Methods The frequency of specific maternal mortalities and morbidities was obtained from: Maternal Death Enquiry (MDE), Hospital In-Patient Enquiry Scheme (HIPE), NPEC National Audit of SMM, and Growing Up in Ireland. The incidence, crude mortality and case-fatality ratios were calculated for each main maternal condition between 2009 and 2017 (i.e. Haemorrhage, Hypertension, Thromboembolism/Venous thromboembolism (VTE) and Sepsis).
The iceberg-effect metaphor was used representing the different epidemiologic levels of the various maternal health conditions studied. At the bottom, a healthy pregnancy, topped by manageable maternity complications, followed by severe maternal morbidities and at the peak, maternal mortality.
As the major morbidity affecting women following pregnancy in Ireland, the incidence rate (per 1000 maternities) of Major Obstetric Haemorrhage (MOH) was calculated. Poisson regression was calculated to obtain rate ratios studying the trend of this morbidity throughout the years.
Results Currently, there are more maternal morbidities (n=619881) than maternities in Ireland (n=604510), an event noticed from 2012 onwards.
At the ‘tip of the iceberg’, thromboembolism (TE) recorded the highest mortality ratio (0.23 among 22 maternal fatalities) followed by MOH (mortality ratio=0.18).
Among the SMMs studied, the case fatality ratio for eclampsia is 25 and for pulmonary embolism this is 26, highest values recorded.
MOH remains the SMM with highest incidence in Ireland (crude rate 28.85). The incidence of MOH increased from 2.34 per 1,000 maternities in 2011 to 3.14 in 2017, an increase of 45% (rate ratio=1.45, 95% CI=1.18–1.77, p-value<0.001).
Sepsis with a case-fatality ratio of 122 recorded the highest value among the group of (non-severe) morbidities studied, as one in 122 cases of this condition might result in death.
Conclusion Although TE and MOH were the main causes of maternal death, pulmonary embolism, eclampsia and sepsis emerged as important issues affecting maternal health.
The study of such issues offers the possibility of carrying preventive actions, prioritise and implement timely intervention to tackle critical pregnancy and maternal health issues. Valuable lessons can be learned about the requirements, care and interventions necessary to ensure a better and more efficient response to the specific needs of these women.
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