National Perinatal Epidemiology Centre publishes Severe Maternal Morbidity in Ireland Annual Report 2014
This is the third report from the national audit of severe maternal morbidity (SMM) in Ireland. It reports on 365 cases of SMM that occurred in Irish maternity units in 2014. It also reports on findings from the first national audit of critical care in obstetrics in Ireland. Fifteen of the 19 Irish maternity units contributed to the critical care in obstetric audit in 2014, including two large tertiary referral maternity units and thirteen smaller maternity units.
NOCA provides assisted governance for all of the NPEC’s audits.
Findings:
- In 2014, the eighteen participating maternity units reported that 365 women experienced SMM, as defined in this audit, constituting a rate of 5.93 per 1,000 maternities.
- From 2011 to 2014, the SMM rate varied from 3.83 to 5.93 per 1,000 maternities or from one in 260 maternities to one in 170 maternities. Respectively, the SMM rate was 16%, 24% and 55% higher in 2012, 2013 and 2014 than in the base year 2011.
- The incidence of major obstetric haemorrhage was 2.76 per 1,000 maternities in 2014. This varied widely across maternity units which may relate to how blood loss is estimated in the unit.
- Half of the women admitted into an ICU/CCU in 2014 had not experienced a severe morbidity as defined by this audit. This phenomenon has increased over the four years of the SMM audit, from 25% in 2011, to 35% in 2012, 41% in 2013 and 48% in 2014.
- The first audit on critical care in obstetrics in Ireland identified that the incidence of women requiring Level 2 Care was 5.19 per 1,000 maternities or one in 193 maternities. For women requiring Level 3 Care, the incidence was 0.57 per 1,000 maternities or one in 1,768 maternities.
Selected Recommendations:
- To estimate blood loss, a quantitative approach (involving volume and weight assessment) should be considered for use in all maternity units. Development of a national tool-kit would assist standardisation of such an approach.
- Where obstetric critical care is provided varies across maternity units according to available resources. ICU/CCU is the usual location in small maternity units, thus appropriate resources and training should be in place to care for the critically ill woman in obstetrics.
- For maternity units with more than 2,500 births, consideration should be given to resourcing the facility to provide Level 2 Care within the maternity unit setting.
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.
The report is available to download from the NPEC website.
If you require a hard copy of the report or if you have any queries, please feel free to contact NPEC at npec@ucc.ie