Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnancies
Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Design Prospective population‐based cohort study. Setting All 98 maternity units in the Netherlands. Population All pregnant women in the Netherlands. Methods Ca...
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| Published in | BJOG : an international journal of obstetrics and gynaecology Vol. 115; no. 7; pp. 842 - 850 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.06.2008
Blackwell Wiley Subscription Services, Inc |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.
Design Prospective population‐based cohort study.
Setting All 98 maternity units in the Netherlands.
Population All pregnant women in the Netherlands.
Methods Cases of severe maternal morbidity were collected during a 2‐year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit.
Main outcome measures Incidence, case fatality rates, possible risk factors and substandard care.
Results Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non‐Western immigrant women had a 1.3‐fold increased risk of severe maternal morbidity (95% CI 1.2–1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit.
Conclusions Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. |
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| AbstractList | Nationwide research in the Netherlands, the LEMMoN study, to assess incidence, case fatality rates, risk factors and substandard care on maternal morbidity. Records from all maternity units in the country supplied information to identify all cases of severe morbidity, specifically ICU admission, uterine rupture, eclampsia/HELLP syndrome and major obstetric haemorrhage. Ethnicity as a risk factor was also studied. [(BNI unique abstract)] 30 references Objective: To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Design: Prospective population-based cohort study. Setting: All 98 maternity units in the Netherlands. Population: All pregnant women in the Netherlands. Methods: Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. Main outcome measures: Incidence, case fatality rates, possible risk factors and substandard care. Results: Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. Conclusions: Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. [PUBLICATION ABSTRACT] To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Prospective population-based cohort study. All 98 maternity units in the Netherlands. All pregnant women in the Netherlands. Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371,021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. Incidence, case fatality rates, possible risk factors and substandard care. Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10,000), eclampsia in 222 women (incidence 6.2/10,000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Design Prospective population‐based cohort study. Setting All 98 maternity units in the Netherlands. Population All pregnant women in the Netherlands. Methods Cases of severe maternal morbidity were collected during a 2‐year period. All pregnant women in the Netherlands in the same period acted as reference cohort ( n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. Main outcome measures Incidence, case fatality rates, possible risk factors and substandard care. Results Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non‐Western immigrant women had a 1.3‐fold increased risk of severe maternal morbidity (95% CI 1.2–1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. Conclusions Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Prospective population-based cohort study. All 98 maternity units in the Netherlands. All pregnant women in the Netherlands. Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. Incidence, case fatality rates, possible risk factors and substandard care. Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. Please cite this paper as: Zwart J, Richters J, Öry F, de Vries J, Bloemenkamp K, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371 000 pregnancies. BJOG 2008;115:842-850. Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Design Prospective population‐based cohort study. Setting All 98 maternity units in the Netherlands. Population All pregnant women in the Netherlands. Methods Cases of severe maternal morbidity were collected during a 2‐year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371 021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit. Main outcome measures Incidence, case fatality rates, possible risk factors and substandard care. Results Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10 000), eclampsia in 222 women (incidence 6.2/10 000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non‐Western immigrant women had a 1.3‐fold increased risk of severe maternal morbidity (95% CI 1.2–1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit. Conclusions Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.OBJECTIVETo assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.Prospective population-based cohort study.DESIGNProspective population-based cohort study.All 98 maternity units in the Netherlands.SETTINGAll 98 maternity units in the Netherlands.All pregnant women in the Netherlands.POPULATIONAll pregnant women in the Netherlands.Cases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371,021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit.METHODSCases of severe maternal morbidity were collected during a 2-year period. All pregnant women in the Netherlands in the same period acted as reference cohort (n = 371,021). As immigrant women are disproportionately represented in Dutch maternal mortality statistics, special attention was paid to the ethnic background. In a subset of 2.5% of women, substandard care was assessed through clinical audit.Incidence, case fatality rates, possible risk factors and substandard care.MAIN OUTCOME MEASURESIncidence, case fatality rates, possible risk factors and substandard care.Severe maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10,000), eclampsia in 222 women (incidence 6.2/10,000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit.RESULTSSevere maternal morbidity was reported in 2552 women, giving an overall incidence of 7.1 per 1000 deliveries. Intensive care unit admission was reported in 847 women (incidence 2.4 per 1000), uterine rupture in 218 women (incidence 6.1/10,000), eclampsia in 222 women (incidence 6.2/10,000) and major obstetric haemorrhage in 1606 women (incidence 4.5 per 1000). Non-Western immigrant women had a 1.3-fold increased risk of severe maternal morbidity (95% CI 1.2-1.5) when compared with Western women. Overall case fatality rate was 1 in 53. Substandard care was found in 39 of a subset of 63 women (62%) through clinical audit.Severe maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge.CONCLUSIONSSevere maternal morbidity complicates at least 0.71% of all pregnancies in the Netherlands, immigrant women experiencing an increased risk. Since substandard care was found in the majority of assessed cases, reduction of severe maternal morbidity seems a mandatory challenge. |
| Author | De Vries, JIP Richters, JM Van Roosmalen, J Zwart, JJ Bloemenkamp, KWM Öry, F |
| Author_xml | – sequence: 1 givenname: JJ surname: Zwart fullname: Zwart, JJ – sequence: 2 givenname: JM surname: Richters fullname: Richters, JM – sequence: 3 givenname: F surname: Öry fullname: Öry, F – sequence: 4 givenname: JIP surname: De Vries fullname: De Vries, JIP – sequence: 5 givenname: KWM surname: Bloemenkamp fullname: Bloemenkamp, KWM – sequence: 6 givenname: J surname: Van Roosmalen fullname: Van Roosmalen, J |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20373164$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/18485162$$D View this record in MEDLINE/PubMed |
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| References | 2001; 322 2007; 19 2005; 173 2006; 119 1993; 307 2005; 112 2005; 118 2002; 2 2007 2005 2004; 1 2005; 25 2007; 114 2004; 111 2007; 370 1991; 23 2006; 21 1997; 74 2002; 146 2007; 132 2004; 57 2008; 115 1998; 105 2002; 109 2006; 128 1998; 79 e_1_2_9_30_2 Van Dillen J (e_1_2_9_25_2) 2006; 119 e_1_2_9_10_2 e_1_2_9_12_2 e_1_2_9_31_2 e_1_2_9_11_2 The Netherlands Perinatal Registry (e_1_2_9_24_2) 2007 Stones W (e_1_2_9_6_2) 1991; 23 e_1_2_9_14_2 e_1_2_9_13_2 e_1_2_9_16_2 e_1_2_9_15_2 e_1_2_9_18_2 e_1_2_9_17_2 e_1_2_9_19_2 e_1_2_9_21_2 e_1_2_9_20_2 e_1_2_9_7_2 e_1_2_9_5_2 e_1_2_9_2_2 Hira Sing RA (e_1_2_9_22_2) 2002; 146 Schutte JM (e_1_2_9_4_2) 2005; 118 e_1_2_9_9_2 e_1_2_9_8_2 Van Duin C (e_1_2_9_23_2) 2002; 2 e_1_2_9_27_2 e_1_2_9_26_2 e_1_2_9_29_2 Lewis G (e_1_2_9_3_2) 2007 e_1_2_9_28_2 19452769 - Ned Tijdschr Geneeskd. 2009 Apr 11;153(15):691-7 |
| References_xml | – volume: 119 start-page: 29 year: 2006 end-page: 34 article-title: [LEMMoN Audit; a pilot study into incidence and assessment of severe maternal morbidity in The Hague] publication-title: Ned Tijdschr Obstet Gynaecol – volume: 173 start-page: 759 year: 2005 end-page: 64 article-title: Severe maternal morbidity in Canada, 1991‐2001 publication-title: CMAJ – volume: 19 start-page: 145 year: 2007 end-page: 50 article-title: Near miss audit in obstetrics publication-title: Curr Opin Obstet Gynecol – year: 2005 – year: 2007 – volume: 132 start-page: 171 year: 2007 end-page: 6 article-title: Obstetric management and outcome of pregnancy in women with a history of caesarean section in the Netherlands publication-title: Eur J Obstet Gynecol Reprod Biol – volume: 57 start-page: 716 year: 2004 end-page: 20 article-title: A scoring system identified near‐miss maternal morbidity during pregnancy publication-title: J Clin Epidemiol – volume: 23 start-page: 13 year: 1991 end-page: 15 article-title: An investigation of maternal morbidity with identification of life‐threatening ‘near miss’ episodes publication-title: Health Trends – volume: 79 start-page: 57 year: 1998 end-page: 62 article-title: Confidential enquiry into maternal deaths in The Netherlands 1983‐1992 publication-title: Eur J Obstet Gynecol Reprod Biol – volume: 307 start-page: 1087 year: 1993 end-page: 8 article-title: Maternal “near miss” reports? publication-title: BMJ – volume: 25 start-page: 7 year: 2005 end-page: 9 article-title: Severe obstetric maternal morbidity: a 15‐year population‐based study publication-title: J Obstet Gynaecol – volume: 322 start-page: 1089 year: 2001 end-page: 93 article-title: Incidence and predictors of severe obstetric morbidity: case‐control study publication-title: BMJ – volume: 118 start-page: 89 year: 2005 end-page: 91 article-title: [Maternal mortality in the Netherlands: the tip of the iceberg] publication-title: Ned Tijdschr Obstet Gynaecol – volume: 114 start-page: 751 year: 2007 end-page: 9 article-title: Investigation of an increase in postpartum haemorrhage in Canada publication-title: BJOG – volume: 74 start-page: 173 year: 1997 end-page: 7 article-title: Case‐control study of risk factors for obstetric patients’ admission to intensive care units publication-title: Eur J Obstet Gynecol Reprod Biol – volume: 128 start-page: 152 year: 2006 end-page: 6 article-title: Obstetric intensive care admissions: a 12‐year review in a tertiary care centre publication-title: Eur J Obstet Gynecol Reprod Biol – volume: 370 start-page: 1311 year: 2007 end-page: 19 article-title: Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data publication-title: Lancet – volume: 2 start-page: 32 year: 2002 end-page: 5 article-title: Sociaal‐economische status indicator op postcodeniveau. 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| Snippet | Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.
Design Prospective... Objective To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Design Prospective... To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Prospective population-based cohort... To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Prospective population-based cohort... Objective: To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands. Design: Prospective... To assess incidence, case fatality rate, risk factors and substandard care in severe maternal morbidity in the Netherlands.OBJECTIVETo assess incidence, case... Nationwide research in the Netherlands, the LEMMoN study, to assess incidence, case fatality rates, risk factors and substandard care on maternal morbidity.... |
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| SubjectTerms | Adolescent Adult Biological and medical sciences Childbirth & labor Delivery. Postpartum. Lactation Epidemiologic Methods Ethnicity Female Gynecology. Andrology. Obstetrics Hospitalization - statistics & numerical data Humans incidence Intensive Care Units - standards maternal mortality Medical sciences Morbidity nationwide Netherlands - epidemiology Obstetrics Pregnancy Pregnancy Complications - epidemiology Pregnancy Complications - ethnology Prenatal Care - standards Risk factors severe maternal morbidity substandard care Uterine Rupture - epidemiology Uterine Rupture - ethnology |
| Title | Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population‐based study of 371 000 pregnancies |
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