Severe maternal morbidity in Ireland annual report 2012 and 2013.

Abstract

This is the second report from the national audit of severe maternal morbidity (SMM) in Ireland. It reports on 615 cases of SMM that occurred in maternity units in 2012 and 2013. There were 292 cases in 2012 notified by nineteen of the country’s 20 maternity units and 323 cases notified for 2013 when all 20 units participated. Over the three years of this audit, the reported incidence of SMM in Irish maternity units increased from 3.83 per 1,000 maternities in 2011 to 4.44 per 1,000 in 2012 and 4.75 per 1,000 in 2013, suggesting an upward trend in SMM. Despite this, the incidence of SMM in Ireland compares favourably with the rate reported from the methodologically comparable national audit in Scottish maternity units (SCASMM) over similar years. The most recently reported Scottish SMM rate is 7.3 per 1,000 maternities for 2012. The majority of the women (70%) who experienced SMM in 2012 and 2013 were diagnosed with one SMM, one in four (24%) were diagnosed with two severe morbidities, 6% with three and 1% of the women were diagnosed with four morbidities. Similar to findings in the Scottish audit, major obstetric haemorrhage (MOH) was the most frequently reported SMM (55%). The next most common reportable SMM events were admission to intensive care unit or coronary care unit (ICU/CCU; 42%), renal or liver dysfunction (7%), peripartum hysterectomy (7%) and pulmonary embolism (6%). The 341 reported MOH cases gave an incidence rate of 2.55 per 1,000 maternities in 2012/2013, less than half the equivalent rate in Scotland for the same years. Uterine atony was the most common underlying cause (38%) of MOH followed by retained placenta/ membranes (17%). This mirrors findings from successive SCASMM reports. The vast majority of MOH cases (84%) occurred during or after birth, 18% occurred in the intrapartum period and two thirds in the postpartum period. Almost all women who experienced MOH (93%) received a blood transfusion. Admission into an ICU/CCU has been used as a marker for SMM internationally and is a reportable event in this audit. MOH was associated with 41% of the 261 ICU/CCU admissions reported for 2012/2013. However, an increasing proportion of reported ICU/CCU cases had no other associated SMM as defined in this audit (25% in 2011, 35% in 2012 and 41% in 2013). Our discussions with the units suggests such ICU/CCU admissions reflect resource issues in maternity units when women need a higher level of monitoring. This finding is one of the motivations for the new NPEC Audit of Critical Care in Obstetrics in Ireland which is currently being implemented in maternity units across the country.