For every case of maternal death, many more women experience life-threatening complications during pregnancy and childbirth. Yet, severe maternal morbidity (SMM) cases are often overlooked post-delivery. Women have reported that roughly 15% of SMM cases first occurred in the six weeks following delivery. The underlying factors associated with these morbidities are likely different than those occurring antenatally and at the time of delivery. Further research is required to elucidate the exact burden of SMM in the postpartum period in British Columbia (BC).
The ratio of maternal morbidity to maternal mortality is increasing globally (Geller 2018). In high-income countries, the World Health Organization (WHO) recommends routinely surveilling SMM to assess maternal health and quality of care (Geller 2018). To our knowledge, this is the first study conducted among pregnancies in BC aiming to examine the cumulative incidence, timing, and factors associated with postpartum maternal morbidity and hospital readmissions. This is a retrospective cohort study will use data from the BC Perinatal Data Registry (BCPDR), which contains maternal, fetal and neonatal health information from 99% of all deliveries in BC. The primary outcome assessed will be the cumulative incidence of hospital readmissions and SMM events occurring after delivery discharge within the first six weeks (42 days) of delivery. Secondary outcomes will include SMM-diagnosis, the rate and timing of postpartum SMM and readmissions, and maternal characteristics associated with these events. A multinominal logistic regression model will examine the association between postpartum SMM or readmission and determinants.
Study Type
OBSERVATIONAL
Enrollment
15,000
This study will review data provided by the BCPDR from April 1, 2008 to March 31, 2021.
Maternal hospital readmission
Cumulative incidence of women who get readmitted into the hospital after being discharged post-delivery
Time frame: Up to six weeks post-delivery discharge
Severe maternal morbidity (SMM) event
Cumulative incidence of women who experience least one SMM event, defined as: severe pre-eclampsia, HELLP, eclampsia; severe haemorrhage; maternal ICU admission; surgical complications; hysterectomy; sepsis; embolism, shock, DIC; assisted ventilation; cardiac conditions; acute renal failure; several uterine rupture; cerebrovascular accidents; and other types of maternal morbidity.
Time frame: Up to six weeks post-delivery discharge
SMM type
Type of SMM event experienced
Time frame: Up to six weeks postpartum
Rate of hospital readmission and SMM events
Frequency of women who get readmitted to the hospital after discharge and/or experienced at least one SMM event
Time frame: Up to six weeks postpartum
Timing of hospital readmission and SMM events
Specific time frames for women who get readmitted to the hospital after discharge and/or experienced at least one SMM event
Time frame: Up to six weeks postpartum
Maternal characteristics
Characteristics associated with hospital readmission and SMM events after delivery discharge, such as age, race, geographic location, fetal outcome, mode of delivery and pre-existing maternal comorbidities (hypertension, diabetes, and mental health conditions).
Time frame: Up to six weeks postpartum
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