From Reuters Health Information

Rates of Severe Obstetric Complications Increased Over Last Decade

www.glorialemay.com/blog



NEW YORK (Reuters Health) Jan 23 - The prevalence of obstetric complications
resulting in severe maternal morbidity -- particularly pulmonary embolism
and need for blood transfusions -- increased significantly in the US between
1998 and 2005, investigators report in the February issue of Obstetrics and
Gynecology.



During the same period, rates of cesarean delivery rose from 21.1% to 31.1%,
Dr. Susan F. Meikle, at the National Institutes of Health in Bethesda,
Maryland, and co-authors note. The proportion of delivery hospitalizations
involving older women and women on Medicaid/Medicare also increased with
time, as did deliveries characterized by multiple births, hypertension, and
diabetes.



However, they point out, "comprehensive population-based information on
severe obstetric complications remains very limited."



To examine trends in severe labor and delivery complications, the authors
used data from the Nationwide Inpatient Sample of the Healthcare Cost and
Utilization Project for more than 32 million delivery discharge records.



The proportion of deliveries with at least one severe obstetric complication
increased from 0.64% in 1998-1999 to 0.81% in 2004-2005, the report
indicates.



There was a 52% increase in pulmonary embolism and a 92% increase in blood
transfusions. Rates of renal failure, respiratory distress syndrome, shock,
and mechanical ventilation increased by about 20%.



By contrast, rates of severe complications of anesthesia declined, and there
were no significant changes in heart failure, puerperal cerebrovascular
disorders, pulmonary edema, deep venous thrombosis, disseminated
intravascular coagulation, and sepsis.



Adjustment for cesarean delivery explained almost all the increases in
estimated risk of renal failure, respiratory distress, and ventilation,
although the authors note that their results "do not demonstrate causality."



Dr. Meikle's team points out that the UK has established a surveillance
system for rare obstetric complications. Development of a similar system in
the US "may improve the ascertainment, monitoring, and classification of
these complications and potentially identify modifiable risk factors."



Obstet Gynecol 2009;113:293-299.



Reuters Health Information C 2009

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