Severe maternal morbidity in a tertiary maternity hospital in Ireland in 2021

ABSTRACT

Objective: Severe Maternal Morbidity (SMM) can be considered a marker of both maternity care and maternal mortality. The aim of this study was to review SMM in 2021 within the National Maternity Hospital (NMH), a tertiary level unit in Dublin, Ireland, with more than 9,000 births per year. Design: The study was a retrospective cohort study of women who experienced SMM in the NMH, Dublin in 2021. Methods: SMM was defined using the criteria established by the National Perinatal Epidemiology Centre (NPEC) in University College Cork. There are 17 reportable morbidities including Major Obstetric Haemorrhage (MOH), Eclampsia, Peripartum Hysterectomy, Anaesthetic complications etc. Data was prospectively recorded from a variety of sources including HDU, Pathology, Placenta Accreta Team, Maternal Medicine Team, Microbiology, Haematology, Anaesthesiology, Labour Ward. Data was included from Jan 1st 2021 to December 31st of the same year. Results: Using the NPEC criteria, 41 women experience at least one SMM during this time, of which four had more than one SMM. As with previous audits and in parallel with National and International data, the most common SMM was MOH with 18 cases. Five women underwent a Peripartum Hysterectomy. Seven women had Renal/Liver Dysfunction, mostly as a result of Pre-eclampsia. Of note, given the context of the COVID pandemic, there were no patients with septic shock due to a COVID infection. There was one late maternal death due to metastatic carcinoma diagnosed during pregnancy. Conclusion: This study highlights the importance of ongoing training for new and established staff members in obstetric emergencies, such as MOH. It also demonstrates importance of audit in the clinical setting, where ongoing reviews highlight issues of importance.