Incidence of severe pre-eclampsia, postpartum haemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population-based study: the MOMS-B survey.

OBJECTIVE: To describe the incidence of three conditions of acute severe maternal morbidity in selected regions in nine European countries.
DESIGN: A population-based questionnaire survey.
SETTING: Eleven regions in nine countries of Europe. POPULATION: All the pregnant women in each region who had delivered during the period covered by the study.
METHODS: Standard definitions of three severe obstetric conditions, pre-eclampsia, postpartum haemorrhage and sepsis were established by a steering committee. A common questionnaire was used in each participating country. The incidence of the three obstetric conditions and characteristics of the study women were compared. MAIN OUTCOME MEASURES: Incidence of three severe obstetric conditions: pre-eclampsia, postpartum haemorrhage and sepsis.
RESULTS: The study identified 1734 women with at least one of the three conditions, with 847 experiencing severe haemorrhage, 793 experiencing severe pre-eclampsia and 142 experiencing severe sepsis. There were wide variations in incidence of three conditions combined, ranging from 14.7 per thousand deliveries in Brussels, Belgium to 6.0 per thousand deliveries in Upper Austria.
CONCLUSIONS: This study sets a simple and straightforward approach to the definition of three severe obstetric conditions and allows population-based comparisons between developed countries in Europe, even though difficulties may have been present with applying the definition across countries. The reported incidence of these severe obstetric conditions in general and severe haemorrhage varied significantly between countries. Overall, severe haemorrhage in particular was the most common of the three conditions, followed closely by severe pre-eclampsia.