This study was designed to 1) identify pregnancy complications and other risk factors that led to severe maternal morbidity during the delivery hospitalization and to 2) estimate the severe maternal morbidity rates in NYC.
We used 1995–2003 NYC birth certificates linked to hospital discharge data to identify delivery hospitalizations with maternal diagnoses and procedures that indicated a possible life-threatening diagnosis or a life-saving procedure. We used indicators described in previous work by Callaghan et al (AJOG, 2008) that were developed on a weighted probability sample to examine morbidity in the entire New York City population. The severe morbidity proportion was defined as the number of women with one or more indicators per 1000 deliveries. This is the first time the indicators have been tested on a complete population.
From 1995-2003 there were 1025677 singleton births in NYC. The severe morbidity proportion was 12.8 per 1000 deliveries (greater than twice that of the previously reported rate). Most women that were classified as having a severe morbidity had ICD-9 codes for respiratory failure, transfusion, hysterectomy or eclampsia. Compared to white women, black women had significantly higher odds of severe morbidity (OR) 2.4 (95% CI 2.3-2.5). Women with Medicaid had significantly higher odds of severe morbidity compared to women with private insurance (OR) 1.5 (95% CI 1.4-1.52). Women who delivered by cesarean had four-fold the odds of severe morbidity than those who delivered vaginally (OR) 4.6 (95% CI 4.5-4.8).
This study shows that morbidity is disproportionate for certain racial and socioeconomic groups. It is important to understand contributors to life-threatening maternal morbidity in order to improve obstetrical care.
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.