Key result
Among 89 cases of severe maternal morbidity associated with severe pre-eclampsia, 31% were assessed as potentially preventable, primarily due to delays in diagnosis and suboptimal treatment.
Why the study?
Pre-eclampsia is a leading cause of severe maternal and neonatal morbidity and mortality, but a significant proportion of these poor outcomes may be preventable with care improvements.
Cohort (n=89)
Yes
A significant proportion (31%) of severe maternal morbidity associated with pre-eclampsia is potentially preventable, highlighting the need for improved risk recognition and timely treatment.
INTRODUCTION: Pre-eclampsia and related sequelae are a leading cause of severe maternal and neonatal morbidity and mortality. A significant proportion of these poor outcomes may be preventable with improvements along the continuum of maternal and neonatal care. AIMS: The aim of this study was to review cases of pre-eclampsia resulting in severe maternal morbidity, describing the maternal and neonatal outcomes and the potential preventability of severe maternal morbidity (SMM). MATERIALS AND METHODS: This was a retrospective cohort study of cases of SMM associated with severe pre-eclampsia - a subset of a national SMM review study. Inclusion criteria for this subset were women who were pregnant or within 42 days of delivery with severe pre-eclampsia as the main reason for admission to an intensive care unit or high dependency unit in New Zealand between 1 August 2013 and 31 January 2015 inclusive. A multidisciplinary expert panel reviewed cases for preventability using a validated preventability tool. RESULTS: Of the 89 severe morbidities that were reviewed, 10 had eclampsia (11%) and there were four neonatal mortalities (4.3%). Multidisciplinary committees assessed the severe morbidity as potentially preventable in 31% (28) of cases with the majority due to delays in diagnosis and suboptimal treatment. CONCLUSION: We found a high level of preventable morbidity in cases of severe pre-eclampsia with a concerning number of preventable eclampsia. Implementation of evidence-based guidelines reinforced with education would assist clinicians to improve risk recognition, timely diagnosis and treatment and decrease potentially preventable severe morbidity associated with pre-eclampsia.
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MacDonald et al. (2019) conducted a cohort in Severe pre-eclampsia resulting in severe maternal morbidity (n=89). Severe pre-eclampsia was evaluated on Potentially preventable severe maternal morbidity. Among 89 cases of severe maternal morbidity associated with severe pre-eclampsia, 31% were assessed as potentially preventable, primarily due to delays in diagnosis and suboptimal treatment.
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