A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt

Objective

To assess the impact of the non-pneumatic anti-shock garment (NASG) on maternal outcome following severe obstetric hemorrhage.

Methods

A non-randomized pre-intervention/intervention study was conducted in 2 tertiary hospitals in Egypt from June 2006 to May 2008. Women with obstetric hemorrhage (estimated blood loss ≥ 1000 mL and/or ≥ 1 sign of shock [systolic blood pressure < 100 mm Hg or pulse > 100 beats per minute]) were treated with either a standardized protocol (pre-intervention) or a standardized protocol plus the NASG (intervention). The primary outcome was extreme adverse outcome (EAO), combining maternal mortality and severe morbidity (cardiac, respiratory, renal, or cerebral dysfunction). Secondary outcomes were measured blood loss, urine output, emergency hysterectomy, and (individually) mortality or morbidity. Analyses were performed to examine independent association of the NASG with EAO.

Results

Mean measured blood loss decreased from 379 mL pre-intervention to 253 mL in the intervention group (P < 0.01). In a multiple logistic regression model, the NASG was associated with reduced odds of EAO (odds ratio 0.38; 95% confidence interval, 0.17-0.85).

Conclusion

The NASG, in addition to standardized protocols at tertiary facilities for obstetric hemorrhage and shock, resulted in lower measured blood loss and reduced EAO.     

A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria

Objective

To determine whether the non-pneumatic anti-shock garment (NASG) can improve maternal outcome.

Methods

Women were enrolled in a pre-intervention phase (n = 83) and an intervention phase (n = 86) at a referral facility in Katsina, Nigeria, from November 2006 to November 2007. Entry criteria were obstetric hemorrhage (≥ 750 mL) and a clinical sign of shock (systolic blood pressure < 100 mm Hg or pulse > 100 beats per minute). To determine differences in demographics, condition on study entry, treatment, and outcome, t tests and χ² tests were used. Relative risk (RR) and 95% confidence interval (CI) were estimated for the primary outcome, mortality.

Results

Mean measured blood loss in the intervention phase was 73.5 ±93.9 mL, compared with 340.4 ± 248.2 mL pre-intervention (P < 0.001). Maternal mortality was lower in the intervention phase than in the pre-intervention phase (7 [8.1%]) vs 21 [25.3%]) (RR 0.32; 95% CI, 0.14-0.72).

Conclusion

The NASG showed potential for reducing blood loss and maternal mortality caused by obstetric hemorrhage-related shock.     

Morbidity and Mortality Associated With Forceps and Vacuum Delivery at Outlet,Low, and Midpelvic Station

Objective

This study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second stage of labour and to estimate whether these associations differed by pelvic station.

Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity

Objective

To identify factors associated with maternal death among women with severe maternal morbidity.

Methods

A retrospective study of 673 women admitted to an obstetric intensive care unit was undertaken. The odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for selected characteristics. The maternal mortality and severe maternal morbidity ratios were determined for groups of complications according to outcome (death or survival).

Results

The risk of maternal death was higher among adolescents (OR 3.3; 95% CI, 1-9.7) and patients referred from other hospitals (OR 9.8; 95% CI, 2.7-53.3). The severe maternal morbidity ratio was 46.6 per 1000 deliveries and the mortality:morbidity ratio 1:37.4. Obstetric complications led to 65.8% of admissions and 50% of maternal deaths. The number of interventions/procedures and total maximum sequential organ failure assessment score were higher in cases of death.

Conclusion

The strong association between interhospital transfer and maternal death suggests delays in diagnosis, management, and referral. Adopting organ dysfunction-based criteria may contribute toward identifying the most severe cases.     

Pregnancy outcome following loop electrosurgical excision procedure (LEEP) a systematic review and meta-analysis

Objective

This study aimed at assessing the association of the relative risk (RR) of adverse pregnancy outcomes with previous treatment of loop electrosurgical excision procedure (LEEP) for the management of cervical intraepithelial neoplasia (CIN).

Methods

Data sources were from MEDLINE, EMBASE, and SCI citation tracking. Selection criteria: The eligible studies had data on pregnancy outcomes of women with or without previous treatment for CIN. Considered outcomes were severe preterm delivery (<34/32 weeks), extreme preterm delivery (<28 weeks), low birth weight (<2,500 g), stillbirth, preterm spontaneous rupture of membranes, perinatal mortality, and neonatal mortality and induction.

Results

36,954 cases and 1,794,174 controls in 4 prospective cohort and 22 retrospective studies were included in this meta-analysis. LEEP was associated with a higher risk of severe preterm delivery (<32 weeks, relative risk 1.98, 95 % CI [1.31, 2.98] 159/11,337 vs. 7,830/860,883), extreme preterm delivery (<28 weeks, RR, 2.33, 95 % CI [1.84, 2.94] 97/9,611 vs. 1,559/618,332), preterm premature rupture of the membranes (RR, 1.88, 95 % CI [1.54, 2.29] 126/2,837 vs. 7,899/313,094), and low birth weight (<2,500 g, RR, 2.48, 95 % CI [1.75, 3.51] 110/1,451 vs. 55/1,742). A cervical length of less than 3 cm was significantly increased in LEEP as compared with that of control group (RR, 4.88, 95 % CI [1.56, 15.25]), but increasing LEEP volume or depth was not associated with an increased rate of preterm birth <37 weeks. And LEEP was not associated with a significantly increased risk of perinatal mortality, cesarean section, stillbirth mortality, neonatal mortality, induction, and neonatal intensive care unit admission.

Conclusions

LEEP is associated with an increased risk of subsequent preterm delivery (<32/34, <28 weeks) and other serious pregnancy outcomes. But increasing LEEP volume or depth is not associated with an increased rate of preterm birth.     

Factors affecting operative blood loss from open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer

Purpose

To evaluate the effect of clinical and tumor factors on operative blood loss during open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer.

Methods

Clinical, pathological, and operative data of 456 women with cervical cancer stage IA2–IIA who had open radical hysterectomy with bilateral pelvic lymphadenectomy (RHPL) from January 2003 to December 2005 were reviewed with regard to operative blood loss of 600?ml or more.

Results

Parity (RR 1.67; 95?% CI 1.02–2.73; p value 0.04) and salpingo-oophorectomy (RR 1.57; 95?% CI 1.06–2.31; p value 0.02) were statistically associated with operative blood loss of 600?ml or more from multivariate analysis. Preoperative chemotherapy (RR 1.87; 95?% CI 1.18–2.96; p value?2 (RR 1.73; 95?% CI 1.08-2.75; p value 0.02) were significantly associated with blood loss of more than 1,000?ml in the multivariate analysis.

Conclusion

High parity (3 or more) and incidental salpingo-oophorectomy are related to an increased risk of operative blood loss of 600?ml or more during open RHPL. However, the effects were marginal and no clear explanation for the underlying mechanisms is available. Preoperative chemotherapy and overweight were independent predictors of operative blood loss of more than 1,000?ml.     

Comparison of outcomes of perinatal care in Slovakia and the UK

Objective

To investigate whether there are differences in maternal and perinatal outcomes between Slovakia and the UK, and whether any observed variations can be attributed to differences in perinatal care.

Methods

Data on outcomes of perinatal care in Slovakia and the UK between 2006 and 2010 were compared. Perinatal mortality figures included stillbirths weighing 1000 g or more and early neonatal deaths.

Results

In Slovakia, the perinatal mortality rate was significantly higher than that in the UK (RR 1.12; 95% CI, 1.06–1.18). Cesarean delivery was significantly more frequent in Slovakia (RR 1.05; 95% CI, 1.05–1.06); instrumental vaginal delivery was less frequent (ventouse delivery, RR 0.20; 95% CI, 0.19–0.21; forceps delivery, RR 0.09; 95% CI, 0.09–0.10). Episiotomy and peripartum hysterectomy were performed more often in Slovakia (episiotomy, RR 4.10; 95% CI, 4.07–4.12; peripartum hysterectomy, RR 2.02; 95% CI 1.65–2.47). The incidence of eclampsia was significantly higher in Slovakia (RR 1.60; 95% CI, 1.26–2.04). There were no significant differences in the rates of maternal death.

Conclusion

Perinatal care outcomes and intervention rates differ between Slovakia and UK. This may be explained by differences in outcome definitions, perinatal care, and official encouragement of medical complaints.     

Severe maternal morbidity during childbirth hospitalisation: a comparative analysis between the Republic of Ireland and Australia

Objective

To determine the population-based rates of severe maternal morbidity during childbirth hospitalisation and associated characteristics in the Republic of Ireland and to directly compare incidence rates with Australia.

Study design

Retrospective cohort study of 330,955 childbirth hospitalisations between 2005 and 2009. Using validated diagnostic criteria from Australia, we examined hospital discharge records (ICD-10-AM) to identify likely cases of severe maternal morbidity. We derived overall and category-specific morbidity incidence rates and examined five-year trends. Unadjusted relative risks were computed to assess sociodemographic and obstetric factors associated with morbidity status.

Results

The severe maternal morbidity five-year incidence rate was 1.34 per 100 deliveries. Between 2005 and 2009, the overall rate of severe morbidity significantly increased from 1.31 to 1.55 cases per 100 deliveries (test for trend p-value <0.001). Similar to Australia, the most frequently diagnosed severe morbidity indicators in Ireland were blood transfusion (112.6 per 10,000 deliveries), evacuation of haematoma (7.2 per 10,000 deliveries) and dilation and curettage with general anaesthesia (3.9 per 10,000 deliveries). In the Irish cohort, the risk of severe morbidity was more than three-fold (RR 3.48; 95% CI: 3.06–3.95) among women carrying multiple gestations and more than four-fold (RR 4.37; 95% CI: 3.66–5.22) among women with a stillbirth. Further, severe morbidity risk was 2.62 times higher among women with a pre-existing medical condition (RR 2.62; CI 2.03–3.37).

Conclusion

Our use of low-cost administrative data to identify severe maternal morbidity contributes to a growing body of international initiatives to inform preventive efforts. The ability to directly compare morbidity rates is advantageous, underscoring the need for a uniform definition of severe morbidity to promote accurate and reliable international comparisons.     

Maternal mortality and severe maternal morbidity from acute fatty liver of pregnancy in the Netherlands

Objective

To assess maternal death and severe maternal morbidity from acute fatty liver of pregnancy (AFLP) in the Netherlands.

Study design

A retrospective study of all cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of severe maternal morbidity in the Netherlands between 2004 and 2006, in which all 98 maternity units in the Netherlands participated. Maternal mortality ratio (MMR) and incidence of severe maternal morbidity were the main outcome measures.

Results

The MMR from direct maternal mortality from AFLP was 0.13 per 100,000 live births (95% CI 0.05-0.29). The incidence of severe maternal morbidity from AFLP was 3.2 per 100,000 deliveries (95% CI 1.8-5.7).

Conclusions

AFLP is a rare condition which still causes severe maternal morbidity and in some cases mortality. Referral to a tertiary care hospital for treatment of this uncommon disease should be considered.     

La sécurité des soins obstétricaux, une affaire de travail d’équipe ; l’expérience canadienne du programme AMPROOB/MOREOB

Objectives

To describe the implementation of the Managing Obstetrical Risk Efficiently (MORE^OB) program and its impact on clinical outcomes and satisfaction of health care professionals.

The program

Of 3 years duration, it is focused on collective learning, communication, teamwork and the multidisciplinary analysis of practices. In Canada, several hospital cohorts have been followed for the long term and the impact of the program was analyzed with a before/after method in terms of maternal and neonatal severe morbidity, claims-related expenses and the perception of working condition.

Results

In Alberta, a significant reduction of 3rd or 4th degree perineal tears (OR: 0.76, CI 95%: 0.64 to 0.92) and of serious neonatal morbidity (OR: 0.82, CI 95%: 0.69 to 0.97) was observed. In Ontario, at the level of hospital liability insurance, a reduction in compensation costs was highlighted. The stress was reduced for 68% of health care professionals.

Conclusion

By establishing a new culture of patient safety, this program was associated with a reduction of severe maternal and neonatal morbidity and the costs associated with it.     

Temporal Variations in Incidence andOutcomes of Critical Illness Among Pregnant and Postpartum Women inCanada: A Population-Based Observational Study

Objective

Pregnancy-associated morbidity results in hundreds of thousands of deaths annually worldwide. Reducing maternal mortality is a key United Nations Millennium Development Goal. Although maternal mortality has declined in high-income countries, contemporary estimates of maternal morbidity and mortality trends in Canada are lacking.

Acceptability of intrapartum HIV counselling and testing in Cameroon

Background

Post partum haemorrhage is a leading cause of maternal death worldwide. It also contributes to maternal morbidity as women may require a hysterectomy to control bleeding, or may require a blood transfusion, which can transmit viral infections. Anti-fibrinolytic agents have been proposed as a treatment for post partum haemorrhage. We conducted a systematic review to assess the effectiveness and safety of anti-fibrinolytic agents in post partum bleeding.

Methods

All randomised controlled trials of anti-fibrinolytic agents given for bleeding during the postpartum period were included in this review. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled trials, Web of Science, metaRegister of controlled trials, LILACS, Reproductive Health Library, African healthline, POPLINE, MedCarib, CINAHL, Clinicaltrials.gov and the reference lists of eligible trials. Two authors extracted data. Methodological quality was assessed by evaluating allocation concealment. The primary outcome was maternal mortality. Secondary outcomes were blood loss, blood transfusion, hysterectomy, mean haemoglobin concentration, thrombo-embolic events and other adverse effects.

Results

We identified three randomised controlled trials involving 461 participants. The trials compared tranexamic acid with no treatment and reported blood loss after delivery. In all three trials, allocation concealment was either inadequate or unclear. The administration of tranexamic acid was associated with a reduction in blood loss of 92 millilitres (95%CI 76 to 109). The most frequently reported adverse effect of tranexamic acid was nausea, although the increase was easily compatible with the play of chance (RR 4.63, 95%CI 0.23 to 95.14).

Conclusion

Tranexamic acid may reduce blood loss in post partum haemorrhage. However, the quality of the currently available evidence is poor. Adequately powered, high quality randomised controlled trials are needed.     

La edad materna como factor de riesgo obstétrico. Resultados perinatales en gestantes de edad avanzada

Objective

To compare perinatal outcomes in women aged 35 years or over with those in a control group aged less than 35 years.

Design

Historical cohort study.

Setting

Valladolid (Spain).

Methods

Univariate analysis was performed with estimation of relative risks (RR). Variables related to epidemiology, pregnancy course and perinatal outcomes were analyzed.

Results

A total of 1,455 deliveries were analyzed, of which 355 involved women aged 35 years or over (24.39%). Older women more frequently showed pregnancy-associated disorders (29.2 vs 15.8%, p < 0.001): gestational diabetes (6.2%, p < 0.0029), first-trimester metrorrhagia (5.6%, p < 0.01), and risk of preterm birth (3.9%, P < 0.007); pregnancy-induced hypertension was also more frequent in this group but this difference was not statistically significant. Induction of labor was more frequently required in the older group (RR = 1.42; 95% CI:1.08-1.87). Cesarean section was required in 47% of older nulliparous women (RR = 1.63; 95% CI: 1.24-2.15). The overall perinatal mortality rate in older patients was 16.5‰, compared with 2.77‰ in the control group. Maternal morbidity was higher in the group of older patients (RR 5.98; 95% CI 1.35-26.54) and mainly consisted of hemorrhagic complications.

Conclusions

Advanced maternal age is associated with a higher frequency of pregnancy-related disorders and a greater incidence of medically-induced delivery and cesarean sections, especially in primiparous mothers. Age therefore influences maternal and fetal morbidity and mortality. Consequently, these women constitute an obstetric risk population requiring special attention which, given the number of older pregnant women, goes beyond the scope of health provisions in our environment.     

The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes

OBJECTIVE: The purpose of this study was to evaluate the relationship between chorioamnionitis and its duration to adverse maternal, fetal, and neonatal outcomes. STUDY DESIGN: This was a 13-university center, prospective observational study. All women at term carrying a singleton gestation who underwent primary cesarean from January 1, 1999 to December 31, 2000 were eligible. Data abstraction was systematic and performed by trained research nurses. Selected adverse outcomes were compared between pregnancies with, and without, clinically diagnosed chorioamnionitis using relative risks (RRs) and 95% CIs. The duration of chorioamnionitis was stratified into 5 intervals (3-6 h,>6-9 h,>9-12 h, and>12 h), and respective outcomes compared by Mantel-Haenszel test for trend. Additionally, regression analysis was used to compute odds ratios (ORs) and 95% CIs for chorioamnionitis duration length as a continuous explanatory variable. RESULTS: 16,650 pregnancies were analyzed, 1965 (12%) with chorioamnionitis, which was associated with significantly increased risks of maternal blood transfusion, uterine atony, septic pelvic thrombophlebitis, and pelvic abscess (RR 2.3-3.7), as well as 5-minute Apgar 相似文献   

Maternal hyperglycemia and adverse pregnancy outcomes in Dar es Salaam,Tanzania

Objective

To evaluate maternal glucose levels during pregnancy as a predictor of adverse perinatal outcomes in Dar es Salaam, Tanzania.

Methods

Random blood glucose measurements were analyzed from 3383 pregnant women enrolled in a randomized trial to assess the impact of multivitamins on pregnancy outcomes in Dar es Salaam between August 2001 and July 2004. Information on maternal and neonatal morbidity was recorded at monthly study visits, delivery, and 6 weeks postpartum. Binomial regression and generalized estimating equations were used to determine the relationship between elevated glucose (> 7.8 mmol/L) and pregnancy outcomes.

Results

In total, 25 women had elevated glucose (0.7%). Hyperglycemia was associated with an increased risk of delivery before 37 weeks [relative risk (RR), 2.11; 95% confidence interval [CI], 1.07–4.13; P = 0.03), delivery before 34 weeks (RR, 4.15; 95% CI, 1.43–12.03, P = 0.009), incident gestational hypertension (RR, 2.90; 95% CI, 1.24–6.76; P = 0.01), low birth weight (RR, 2.87; 95% CI, 1.18–6.99; P = 0.02), reduced newborn head circumference (mean difference, –1.57; 95% CI, –2.51 to − 0.62; P = 0.001), and fetal loss (RR, 3.38; 95% CI, 1.13–10.08; P = 0.03).

Conclusion

Maternal hyperglycemia is uncommon among pregnant Tanzanian women, but nonetheless seems to increase the risk of several adverse perinatal outcomes.     

Factors associated with maternal near-miss morbidity and mortality in Kowloon Hospital,Suzhou, China

Objective

To investigate factors associated with acute maternal morbidity and mortality in Kowloon Hospital, Suzhou, China.

Methods

Data from cases of near-miss and maternal death between January 2008 and December 2012 were reviewed retrospectively. Maternal characteristics and related factors were identified, and multiple regression analysis was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results

During the study period, there were 18 104 deliveries, 69 near-miss cases, and 3 maternal deaths. Women who had no health insurance (aOR, 4.55; 95% CI, 0.87–21.8), had fewer than 6 prenatal consultations (aOR, 6.76; 95% CI, 0.76–45.8), were part of a migrant population (aOR, 2.34; 95% CI, 0.45–24.9), or delayed seeking healthcare (aOR, 4.76; 95% CI, 0.89–13.6) had a greater risk of near-miss morbidity or death. Admission to intensive care (aOR, 6.75; 95% CI, 0.89–34.6) and blood transfusion within 30 min (aOR, 3.79; 95% CI, 0.65–8.67) were protective factors in disease progression.

Conclusion

The factors associated with maternal near-miss morbidity and mortality were closely related to health insurance and socioeconomic status, suggesting that the government should take an active role in the community in preventing morbidity and mortality in pregnancy.     

Effects of a single course of corticosteroids given more than 7 days before birth: a systematic review

OBJECTIVES: To determine the risk of fetal, neonatal and maternal mortality and morbidity for women and their infants who remained undelivered more than 7 days following a course of prenatal corticosteroids. DESIGN: Systematic review. POPULATION: Women who gave birth more than 7 days after a course of prenatal corticosteroids compared with women not administered corticosteroids. METHODS: Seven randomised controlled trials were identified which reported outcomes for women and their babies who remained undelivered more than 7 days after exposure to a single course of corticosteroids compared with a placebo/no treatment group. MAIN OUTCOME MEASURES: Fetal, neonatal and maternal mortality and morbidity. RESULTS: Seven trials involving 862 infants, 434 born to corticosteroid treated women and 428 to control women were included in this review. For corticosteroid treated infants there was no reduction in the risk of respiratory distress syndrome (relative risk (RR), 0.72; 95% confidence interval (CI), 0.49-1.07), or stillbirth (RR, 1.67; 95% CI, 0.86-3.25). However, there was a tripling in risk of death for liveborn corticosteroid treated infants (RR, 3.24; 95% CI, 1.32-7.96; P = 0.01), and a doubling in risk of perinatal mortality (RR, 2.13; 95% CI, 1.27-3.57; P < 0.01). Corticosteroid treated infants were born on average 5 days earlier than controls (95% CI, -9.15 to -0.85 days, P = 0.02). Their mothers were more likely to have chorioamnionitis (RR, 2.91; 95% CI, 1.25-6.74; P = 0.01). CONCLUSIONS: Infants exposed to corticosteroids more than 7 days before birth had no reduction in risk of respiratory distress syndrome but increased perinatal mortality.     

Duration of passive and active phases of the second stage of labour and risk of severe postpartum haemorrhage in low-risk nulliparous women

Objective

To assess the risk of severe postpartum haemorrhage (PPH) according to the durations of the passive and active phases of the second stage of labour.

Study design

Secondary analysis from the PREMODA prospective observational study in 138 French maternity units; 3330 low-risk nulliparous women with vaginal deliveries of cephalic singletons were included. Prospective analysis of the recorded durations of the active first stage of labour and the passive and active phases of the second stage of labour was undertaken, and their association with severe PPH, defined by estimated blood loss >1000 ml or blood transfusion. Factors associated with severe PPH were analysed by uni and multivariate analyses with logistic regression models.

Results

The frequency of severe PPH was 2.1% (n = 69). In the univariate analysis, the frequency of severe PPH increased with the duration of the active second stage but not the passive second stage: 1.2% for active second stage <10 min, 1.6% for 10–19 min, 2.1% for 20–29 min, 2.6% for 30–39 min, 4.5% for 40–49 min and 14.3% for ≥50 min (p < 0.001). After adjustment for confounding factors, the risk of severe PPH was found to be statistically significant when the active first stage exceeded 6 h [adjusted odds ratio (OR) 2.5, 95% confidence interval (CI) 1.0–6.1)] and when the active second stage exceeded 40 min (40–49 min: adjusted OR 3.5, 95% CI 1.0–12.3; ≥50 min: adjusted OR 10.6, 95% CI 2.8–40.3; reference: <10 min). The duration of the active second stage was not associated with other maternal or neonatal complications.

Conclusions

A prolonged active, but not passive, second stage of labour is associated with the risk of severe PPH in nulliparas. The optimal duration of these phases remains to be defined.     

A cluster randomized controlled trial to evaluate the effectiveness of the clinically integrated RHL evidence -based medicine course

Objective

to develop and validate a questionnaire on severe maternal morbidity and to evaluate the maternal recall of complications related to pregnancy and childbirth. Design: validity of a questionnaire as diagnostic instrument. Setting: a third level referral maternity in Campinas, Brazil. Population: 386 survivors of severe maternal complications and 123 women that delivered without major complications between 2002 and 2007.

Methods

eligible women were traced and interviewed by telephone on the occurrence of obstetric complications and events related to their treatment. Their answers were compared with their medical records as gold standard. Sensitivity, specificity and likelihood ratios plus their correspondent 95% confidence intervals were used as main estimators of accuracy. Main outcomes: diagnosis of severe maternal morbidity associated with past pregnancies, including hemorrhage, eclampsia, infections, jaundice and related procedures (hysterectomy, admission to ICU, blood transfusion, laparotomy, inter-hospital transfer, mechanical ventilation and post partum stay above seven days).

Results

Women did not recall accurately the occurrence of obstetric complications, especially hemorrhage and infection. The likelihood ratios were < 5 for hemorrhage and infection, while for eclampsia it almost reached 10. The information recalled by women regarding hysterectomy, intensive care unit admission and blood transfusion were found to be highly correlated with finding evidence of the event in the medical records (likelihood ratios ranging from 12.7-240). The higher length of time between delivery and interview was associated with poor recall.

Conclusion

Process indicators are better recalled by women than obstetric complication and should be considered when applying a questionnaire on severe maternal morbidity.     

Maternal and neonatal outcomes following methadone substitution during pregnancy

Purpose

To assess the maternal and neonatal outcomes of pregnant women enrolled on a Methadone Substitution Programme (MSP).

Design

Retrospective cohort study.

Setting

Maternity unit of a London teaching hospital and tertiary referral centre.

Subjects

Pregnant women on a MSP whose antenatal care and delivery was at St Thomas’ Hospital (STH) between January 2005 and March 2008. Controls were non-MSP mothers closely matched for age, parity and delivery date during the same period.

Methods

Maternal data was collected from the Liaison Antenatal Drugs and Alcohol Service clinic records and the STH Maternity Unit’s computerised database. Neonatal data was extracted from the STH Neonatal database (part of the UK National Neonatal database).

Outcome measures

Maternal profiles (age, gravidity, parity, ethnicity, BMI, smoking and alcohol history, relationship and employment history), pregnancy details and mode of delivery. Neonatal outcome measures to include gestation age at delivery, birth weight, head circumference, admission rates and length of stay on Special Care Baby Unit plus Neonatal Abstinence Syndrome (NAS) rates, scoring and treatment.

Results

Compared to the non-MSP mothers (n?=?88) the MSP group (n?=?44) booked later and had a higher incidence of smoking (6.8 vs. 84.1?%), alcohol consumption (10.2 vs. 34.1?%). As a group, they had adverse social background. The MSP group had a higher relative risk (RR) of premature delivery [RR?=?2.5, 95% confidence interval (CI) 1.66–3.88] and had lower birth weight babies (adjusted RR?=?2.2; 95% CI 1.31–3.71) with smaller head circumferences (adjusted RR 1.9; 95% CI 1.06–3.38). NAS occurred in 27?% (95% CI 15.0–42.8) of the MSP group. There was no difference in congenital abnormality between the two groups, but caesarean section rate was higher in the control group.

Conclusion

Opiate-addicted mothers have adverse perinatal outcomes even on MSPs. In addition to the drug effect associated social, relationship and accommodation problems should also be addressed as they may affect the outcome. Pregnancy care for these women needs to continue to develop to improve overall outcomes.