Severe Maternal Morbidity in Ireland Annual Report 2016
The National Perinatal Epidemiology Centre publishes Severe Maternal Morbidity in Ireland Annual Report 2016. This is the fifth report from the national clinical audit of severe maternal morbidity (SMM) in Ireland. It reports on 406 cases of SMM that occurred in all 19 Irish maternity units in 2016. It also reports on findings from the third and final year of the Confidential Audit of Critical Care in Obstetrics in Ireland. Fifteen of the 19 Irish maternity units contributed data to the critical care in obstetric audit in 2016, including two large tertiary referral maternity units and thirteen smaller maternity units.
Severe Maternal Morbidity. The SMM rate is a composite rate of a group of clearly defined severe morbidities. There was a statistically significant increase in the rate of Severe Maternal Morbidity (SMM) and major obstetric haemorrhage (MOH) in 2016 compared to the base year 2011. The rate of SMM was 6.46 per 1,000 maternities or one in 155 maternities. MOH remains the most commonly reported morbidity. Variation in rates of SMM and MOH were identified between units. Multiple pregnancy was associated with an almost fourfold increased risk of SMM. The perinatal mortality rate among infants in women experiencing SMM is approximately seven times the rate observed for all births in Ireland.
Confidential Audit of Critical Care in Obstetrics in Ireland:
One in 109 women required either Level 2 Care and/or Level 3 Care. The need for higher levels of maternal care is not predictable in approximately half of cases and thus has implications for resource planning.
The NPEC encourages all units to collect Robson Ten Group Classification System data in order to facilitate local and national audit. A public health education programme on maternal morbidity and modifiable risk factors should be developed. Maternal Newborn Clinical Management System (MN_CMS) data from Irish maternity units should be collated to identify the influence of risk factors for SMM in Ireland including: ethnicity, maternal age, body mass index (BMI), smoking and employment status. The findings of this national audit highlight the clear need for on-going prospective audit in order to identify adverse maternal outcomes. Although SMM may reflect the complexity of the pregnant population, it also acts as a surrogate measure of quality of care in the maternity services.