Hitti J, et al. - In this retrospective cross-sectional analysis, the association between hypertensive disorders and severe maternal morbidity was evaluated at a regional perinatal referral center. The proportion of severe maternal morbidity diagnoses that were present on admission, in contrast to those arising during the delivery hospitalization was also assessed. Findings revealed a strong dose-dependent relationship between hypertensive disorders in pregnancy and severe maternal morbidity, suggesting the significance of the inclusion of early recognition and management of hypertension in strategies addressing rising maternal morbidity rates. In addition, prevention strategies focussing on hypertension might influence the medically indicated preterm deliveries. Researchers identified increased severe maternal morbidity among American Indian/Alaskan Native women, a disadvantaged population in Washington State, highlighting the influence of socioeconomic factors on adverse maternal health outcomes. As 39% of severe maternal morbidity diagnoses were present on admission, they recommend risk-adjusting this measure, if used as a quality metric for comparison between hospitals.

Methods

• Researchers performed a retrospective cross-sectional analysis including all 7025 women who delivered at the University of Washington Medical Center from Oct. 1, 2013, through May 31, 2017.
• The women were assessd for the rates of severe maternal morbidity diagnoses (eg, renal insufficiency, shock, and sepsis) and procedures (eg, transfusion and hysterectomy).
• From prespecified International Classification of Diseases diagnosis and procedure codes, they assessed severe maternal morbidity.
• Via performing a chart review, they confirmed all diagnoses.
• Using hospital administrative data provided by the Vizient University Health System Consortium, they calculated present-on-admission rates for each diagnosis.
• Women with and without severe maternal morbidity were compared regarding maternal demographic and clinical characteristics.
• Statistical significance was determined using the X² and Fisher exact tests.
• For the associations between maternal demographic and clinical characteristics and severe maternal morbidity, they calculated odds ratios and 95% confidence intervals.

Results

• Severe maternal morbidity was observed in 284 (4%) of 7025 deliveries; 154 had transfusion only, 27 had other procedures, and 103 women had 149 severe maternal morbidity diagnoses (26 women had multiple diagnoses).
• Researchers noted severe preeclampsia in 438 deliveries (6.2%).
• A dose-dependent relationship was noted between hypertension and severe maternal morbidity, with the strongest association observed for preeclampsia with severe features (odds ratio, 5.4; 95% confidence interval, 3.9–7.3).
• Findings revealed significant correlation of severe maternal morbidity with preeclampsia without severe features, chronic hypertension, preterm delivery, pregestational diabetes, and multiple gestation.
• Over one third of preterm births were associated with maternal hypertension among women with severe maternal morbidity.
• Significantly higher severe maternal morbidity rates were evident among American Indian/Alaskan Native women compared to other racial/ethnic groups (11.7% vs 3.9% for whites, P < .01).
• Severe maternal morbidity diagnoses were present in 39.6% of women at admission.