Perinatal outcome of severe obstetric complications: findings of a 10-year hospital-based surveillance study in Italy
Received 28 January 2019
Accepted for publication 1 August 2019
Published 19 August 2019 Volume 2019:11 Pages 463—469
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Elie Al-Chaer
Giovanni Zanconato,1 Elena Cavaliere,2 Olga Mariotto,1 Nicoletta Zatti1
1Department of Surgical Sciences, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy; 2U.O. di Ginecologia e Ostetricia, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
Correspondence: Giovanni Zanconato
U.O. di Ginecologia e Ostetricia, Ospedale Donna Bambino, Polo Ospedaliero di Borgo Trento, Verona 37121, Italy
Fax +39 045 802 7481
Objective: To assess incidence and clinical patterns of severe maternal morbidities related to pregnancy. To determine associated feto-maternal outcomes and economic costs for the institution.
Methods: Observational study in a tertiary care Italian public hospital during a 10-year period. To identify severe obstetric complications, the following management-based criteria were adopted: need for intensive care unit admission, blood transfusion ≥5 units, emergency peripartum hysterectomy/laparotomy and arterial embolization. Impact of severe obstetric complications on facility resources was estimated considering length of hospital stay, need for additional surgery and transfusion.
Results: A total of 151 cases were identified, most frequent obstetric morbidities being major obstetric hemorrhage (50.3%) and hypertensive disorders (19.2%). Pre-term birth, caesarean section and sub-saharan African origin were factors significantly associated with severe morbidity. Maternal mortality and maternal mortality to morbidity ratios were 17 per 100,000 live births and 3:151, respectively. Stillbirth rate was 4.4%. Massive use of blood products and prolonged admissions concurred to increase hospital expenditures.
Conclusion: Institutional severe maternal morbidities may be effectively monitored by implementing a surveillance program and selecting a combination of management-based criteria which define the extremely morbid cases. Focusing on causes and risk factors associated with adverse obstetric situations has the potential to improve quality of care, prevent maternal life-threatening complications and perinatal mortality, reduce hospital expenditures.
Keywords: maternal near miss, organ dysfunction, severe obstetric morbidity, intensive care unit
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]