Incidence and preventability of severe early pregnancy morbidity at a tertiary referral center

Objectives To identify the incidence of severe early pregnancy morbidity (SEPM) by adapting severe maternal morbidity (SMM) definitions to pregnancies <24 weeks; secondarily, to assess preventability of these events using a validated tool Methods This is a retrospective cohort study of pregnant patients at a single tertiary care institution between January 1, 2017 and December 31, 2023. Individuals with a documented pregnancy episode or Current Procedural Terminology (CPT) code denoting an abortive outcome of pregnancy were included. We identified hospital encounters at <24 0/7 weeks’ gestation. Using International Classification of Diseases, 10th revision (ICD‐10) diagnosis codes, blood product administration records, and intensive care transfer records, we identified encounters with possible SEPM using the following three methods: Centers for Disease Control (CDC) SMM diagnosis codes; American College of Obstetricians and Gynecologists (ACOG)/Society of Maternal Fetal Medicine (SMFM) criteria (transfusion of ≥4 units of blood products or intensive care unit [ICU] transfer); or abortion‐related morbidity, which is defined as pelvic infection, damage to pelvic organs, or hemorrhage with estimated blood loss >500 cc or requiring urgent intervention. We reviewed the electronic health record of all screen‐positive cases to verify the presence of an SEPM event, assess preventability using the Alliance for Innovation on Maternal Health SMM review form, and screen for influence of abortion restrictions. Results Of 46,181 pregnant patients, 407 (0.88% of all pregnancies) SEPM events were identified, with 233, 87, and 253 events meeting CDC, ACOG, and abortion‐related morbidity criteria, respectively. Median gestational age at SEPM was 14 weeks (interquartile range [IQR] 9). Common SEPM events were hemorrhage (221; 0.47%), blood transfusion (126; 0.27%), ICU transfer (67; 0.15%), and sepsis (58; 0.13%). Common underlying etiologies were early pregnancy loss (130/407, 32%), non‐obstetric infection (53/407, 13%), premature rupture of membranes or obstetric infection (42/407, 10%), pre‐existing conditions (42/407, 10%), and ectopic pregnancy (37/407, 9%). SEPM was preventable in 126/407 (31%) of events, and 54/126 (43%) of preventability was related to restrictive abortion laws. Conclusions SEPM contributes to preventable morbidity and may be affected by abortion restrictions.