Anne A Chantry1,2, Sylvan Berrut3, Serena Donati4, Mika Gissler5,6, Raphael Goldacre7, Marian Knight8, Alice Maraschini4, Kirsten Monteath9,10, Anna Morris11, Cristina Teixeira12, Rachael Wood9,10, Jennifer Zeitlin1, Catherine Deneux-Tharaux1. 1. INSERM UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France. 2. Midwifery School of Baudelocque, Assistance Publique-Hôpitaux de Paris, DHU Risks in Pregnancy, Paris-Descartes University, Paris, France. 3. Federal Statistical Office, Neuchâtel, Switzerland. 4. Maternal and Child Health Unit, National Centre for Disease Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy. 5. Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland. 6. Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden. 7. Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK. 8. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 9. Information Services Division, NHS National Services Scotland, Edinburgh, UK. 10. Department of Child Life and Health, University of Edinburgh, Edinburgh, UK. 11. Information Services Department, NHS Wales Informatics Service, Cardiff, UK. 12. EPI Unit Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
Abstract
BACKGROUND: Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated. OBJECTIVE: To assess the feasibility of monitoring SAMM using common definitions from hospital discharge databases across Europe. METHODS: We used hospital discharge data in eight countries (2 826 868 deliveries) to identify women with SAMM among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. Five SAMM indicators were investigated: eclampsia, septicaemia, hysterectomy, hysterectomy associated with a diagnosis of obstetric haemorrhage, and red blood cell (RBC) transfusion associated with a diagnosis of obstetric haemorrhage. Between-country variation was described, by the ratio of the highest to lowest rates, while external validation was assessed by comparing with population-based studies on maternal morbidity. RESULTS: Ratios for hysterectomy and red blood cell (RBC) transfusion in the context of obstetric haemorrhage were 1:2.1 and 1:3.5, respectively. High values of hysterectomy and low values of transfusion were both consistent with high maternal mortality from haemorrhage (France, Italy, Portugal). Ratios across countries were relatively low for eclampsia (1:3.4) but very high for septicaemia (1:22.5). Compared to population-based morbidity estimates, eclampsia was over-reported in hospital databases whereas the two indicators of severe haemorrhage had good external validity. CONCLUSIONS: In association with diagnosis codes indicating obstetric haemorrhage, hysterectomy and RBC transfusion appear to be good candidates for surveillance of maternal morbidity in Europe.
BACKGROUND: Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated. OBJECTIVE: To assess the feasibility of monitoring SAMM using common definitions from hospital discharge databases across Europe. METHODS: We used hospital discharge data in eight countries (2 826 868 deliveries) to identify women with SAMM among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. Five SAMM indicators were investigated: eclampsia, septicaemia, hysterectomy, hysterectomy associated with a diagnosis of obstetric haemorrhage, and red blood cell (RBC) transfusion associated with a diagnosis of obstetric haemorrhage. Between-country variation was described, by the ratio of the highest to lowest rates, while external validation was assessed by comparing with population-based studies on maternal morbidity. RESULTS: Ratios for hysterectomy and red blood cell (RBC) transfusion in the context of obstetric haemorrhage were 1:2.1 and 1:3.5, respectively. High values of hysterectomy and low values of transfusion were both consistent with high maternal mortality from haemorrhage (France, Italy, Portugal). Ratios across countries were relatively low for eclampsia (1:3.4) but very high for septicaemia (1:22.5). Compared to population-based morbidity estimates, eclampsia was over-reported in hospital databases whereas the two indicators of severe haemorrhage had good external validity. CONCLUSIONS: In association with diagnosis codes indicating obstetric haemorrhage, hysterectomy and RBC transfusion appear to be good candidates for surveillance of maternal morbidity in Europe.
Authors: Suzan L Carmichael; Barbara Abrams; Alison El Ayadi; Henry C Lee; Can Liu; Deirdre J Lyell; Audrey Lyndon; Elliott K Main; Mahasin Mujahid; Lu Tian; Jonathan M Snowden Journal: Womens Health Issues Date: 2021-12-28