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Severe Maternal Morbidity during Delivery Hospitalization in California Among Women with Stillbirth
Abstract Number: T1B-3
Abstract Type: Original Research
Objective: In the US, reducing severe maternal morbidity (SMM) is a major obstetric priority.(1) Limited population-level data exists examining SMM rates among women experiencing stillbirth. We sought to characterize the prevalence and the most common indicators of SMM at delivery among women with stillbirths.
Study Design: Linked birth certificate and maternal discharge data were used to identify women with stillbirths who underwent delivery hospitalization in California between 1997-2011. We included deliveries occurring between ≥20 weeks and <43 weeks gestation. SMM was defined based on the presence of CDC-recommended ICD-9 diagnosis or procedure codes. The prevalence of SMM during delivery hospitalization was compared between women experiencing stillbirth vs. livebirth. P<0.05 was considered as statistically significant.
Results: We identified 7,168,944 deliveries, of which 29,459 (0.4%) occurred in women with stillbirths and 7,139,485 (99.6%) occurred in women with livebirths. The overall rate of SMM was significantly higher among women experiencing stillbirths compared to livebirths (56/1000 stillbirths vs 11/1000 livebirths, respectively; P<0.001). The rate of SMM among women experiencing stillbirth increased from 64/1000 in 1997 to 71/1000 in 2011 – a 10.9% increase. The 6 most common indicators of SMM among stillbirths were transfusion, DIC, acute renal failure, ARDS, sepsis, and shock (Table). Each complication occurred more frequently among women experiencing stillbirths compared to livebirths (Table).
Conclusion: The rate of SMM during delivery hospitalization among women experiencing stillbirth is 5 times higher than for those experiencing livebirth. These findings indicate that SMM among women experiencing stillbirths is an underappreciated public health concern. Further studies that identify factors that account for the high rate of SMM associated with stillbirth would be informative to the poorly understood etiology of stillbirth as well as to the prognosis among women experiencing stillbirths.
References: 1. Am J Obstet Gynecol 2013; 208: 442e8