Objective To assess the incidence of severe maternal morbidity (SMM) and examine associated factors in Ireland.
Methods In 2011, 67,806 maternities were reported from 19 maternity units, representing 93% of maternities in Ireland. SMM was classified as the presence of one or more of 15 categories of morbidity including: major obstetric haemorrhage (MOH), eclampsia, renal/liver dysfunction, cardiac arrest, pulmonary oedema, acute respiratory dysfunction, coma, cerebrovascular accident, status epilepticus, septicaemic shock, anaesthetic complications, pulmonary embolism, peripartum hysterectomy, ICU admission and interventional radiology. MOH criteria included an estimated blood loss of ≥2,500 ml, a transfusion of ≥5 units of blood or documented coagulopathy treatment. The methodology was based on the Scottish Confidential Audit of Severe Maternal Morbidity (SCASMM).
Results Overall, 260 women experienced SMM, a national rate of 3.8 per 1,000 maternities. Almost half (42.3%) experienced two or more severe morbidities. The perinatal mortality rate for women experiencing SMM was five times the national rate (32.6 vs. 6.6 per 1,000 births). MOH was the most frequent SMM (61.2%, 2.3/1000maternities) followed by ICU admission (42.7%, 1.6/1000maternities), renal/liver dysfunction (10.0%, 0.4/1000 maternities) and peripartum hysterectomy (8.8%, 0.3/1000 maternities). MOH was associated with Caesarean section and peripartum hysterectomy was associated with a history of Caesarean section and a morbidly adherent placenta.
Conclusion The incidence of SMM in Ireland compares favourably to international Figures. 2–4 However, the current trend of increasing Caesarean section rates in Ireland may lead to an increase in SMM. Ongoing national audit of SMM is critical to assessing trends and informing clinical practice.
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