Beverley Lawton1, Evelyn Jane MacDonald2, Selina Ann Brown2, Leona Wilson3, James Stanley2, John David Tait4, Richard Alan Dinsdale5, Carolyn Lee Coles4, Stacie E Geller6. 1. Women's Health Research Center, Department of Primary Care, University of Otago, Wellington, New Zealand. Electronic address: Bev.lawton@otago.ac.nz. 2. Women's Health Research Center, Department of Primary Care, University of Otago, Wellington, New Zealand. 3. Department of Anesthesia, Capital and Coast District Health Board, Wellington, New Zealand. 4. Women's Health Service, Capital and Coast District Health Board, Wellington, New Zealand. 5. Department of Intensive Care, Capital and Coast District Health Board, Wellington, New Zealand. 6. Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL.
Abstract
OBJECTIVE: We sought to assess potential preventability of severe acute maternal morbidity (SAMM) cases admitted to intensive-care units (ICUs) or high-dependency units (HDUs). STUDY DESIGN: Inclusion criteria were admissions to ICUs or HDUs of women who were pregnant or within 42 days of delivery in 4 District Health Board areas (accounting for a third of annual births in New Zealand) during a 17-month period. Cases were reviewed by external multidisciplinary panels using a validated model for assessing preventability. RESULTS: In all, 98 SAMM cases were assessed; 38 (38.8%) cases were deemed potentially preventable, 36 (36.7%) not preventable but improvement in care was needed, and 24 (24.5%) not preventable. The most frequent preventable factors were clinician related: delay or failure in diagnosis or recognition of high-risk status (51%); and delay or inappropriate treatment (70%). The most common causes of preventable severe morbidity were blood loss and septicemia. CONCLUSION: The majority of SAMM cases were potentially preventable or required improvement in care. Themes around substandard care related to delay in diagnosis and treatment for postpartum hemorrhage and septicemia. These findings can inform clinical educational programs and policies to improve maternal outcomes. This study has now been expanded to a national New Zealand audit of all SAMM cases admitted to an ICU/HDU.
OBJECTIVE: We sought to assess potential preventability of severe acute maternal morbidity (SAMM) cases admitted to intensive-care units (ICUs) or high-dependency units (HDUs). STUDY DESIGN: Inclusion criteria were admissions to ICUs or HDUs of women who were pregnant or within 42 days of delivery in 4 District Health Board areas (accounting for a third of annual births in New Zealand) during a 17-month period. Cases were reviewed by external multidisciplinary panels using a validated model for assessing preventability. RESULTS: In all, 98 SAMM cases were assessed; 38 (38.8%) cases were deemed potentially preventable, 36 (36.7%) not preventable but improvement in care was needed, and 24 (24.5%) not preventable. The most frequent preventable factors were clinician related: delay or failure in diagnosis or recognition of high-risk status (51%); and delay or inappropriate treatment (70%). The most common causes of preventable severe morbidity were blood loss and septicemia. CONCLUSION: The majority of SAMM cases were potentially preventable or required improvement in care. Themes around substandard care related to delay in diagnosis and treatment for postpartum hemorrhage and septicemia. These findings can inform clinical educational programs and policies to improve maternal outcomes. This study has now been expanded to a national New Zealand audit of all SAMM cases admitted to an ICU/HDU.
Authors: Kylea L Liese; Mulubrhan Mogos; Sarah Abboud; Karen Decocker; Abigail R Koch; Stacie E Geller Journal: J Racial Ethn Health Disparities Date: 2019-03-15
Authors: Michelle P Debbink; Torri D Metz; Richard E Nelson; Sophie E Janes; Alexandra Kroes; Lori J Begaye; Cara C Heuser; Marcela C Smid; Robert M Silver; Michael W Varner; Brett D Einerson Journal: Am J Perinatol Date: 2021-12-02 Impact factor: 3.079
Authors: Suzan M de Visser; Mallory D Woiski; Richard P Grol; Frank P H A Vandenbussche; Marlies E J L Hulscher; Hubertina C J Scheepers; Rosella P M G Hermens Journal: BMC Pregnancy Childbirth Date: 2018-02-08 Impact factor: 3.007
Authors: Susie Dzakpasu; Paromita Deb-Rinker; Laura Arbour; Elizabeth K Darling; Michael S Kramer; Shiliang Liu; Wei Luo; Phil A Murphy; Chantal Nelson; Joel G Ray; Heather Scott; Michiel VandenHof; K S Joseph Journal: Paediatr Perinat Epidemiol Date: 2019-08-12 Impact factor: 3.980
Authors: Stacie E Geller; Abigail R Koch; Caitlin E Garland; E Jane MacDonald; Francesca Storey; Beverley Lawton Journal: Reprod Health Date: 2018-06-22 Impact factor: 3.223