The rate of pregnant U.S. women experiencing complications during labor increased by 45% from 2006 through 2015, according to a report released this month by the Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP).
For the report, researchers examined severe maternal morbidity—which refers to adverse events resulting from labor, including life-threatening pregnancy complications such as acute myocardial infarction, pulmonary embolism, and sepsis—from 2006 through the third quarter of 2015. The researchers analyzed data from HCUP State Inpatient Databases, which include hospital administrative data, diagnosis and procedure information, patient discharge statuses, and patient demographic information.
The report did not provide an explanation for trends in severe maternal morbidity.
Overall, the researchers found from 2006 through 2015 the rate of severe complications during labor rose from 101.3 severe complications per 10,000 delivery hospitalizations to 146.6 severe complications per 10,000 delivery hospitalizations. According to the researchers, the rates of kidney failure, shock, sepsis, and ventilator use increased twofold from 2006 through 2015, while the rate of blood transfusions—which indicate hemorrhaging and occur in response to serious complications such as a hysterectomy or shock—grew by 54%.
The researchers found the highest rates of severe morbidity occurred among women who were:
- Living in large urban areas;
- Older than 40; and
- Low-income, uninsured, or covered by Medicaid.
In contrast, the researchers found the lowest rates of severe morbidity occurred among women ages 20 to 29.
The researchers also found that minority women disproportionately experienced severe complications during labor. In particular, the researchers found that, when compared with white women:
- Black women were between 112% and 115% more likely to experience severe complications during labor;
- Hispanic women were 40% more likely to experience severe complications during labor; and
- Asian/Pacific Islander women were 20% more likely to experience severe complications during labor.
In addition, the researchers found that while maternal death rates declined overall, in-hospital mortality was three times higher among black women than among white women in 2015. According to the researchers, 11 black women died per 100,000 deliveries in 2015, compared with four white women per 100,000 deliveries.
A 'disturbing trend'—and how hospitals can help
Megan Hambrick, a program analyst with AHRQ, said the rising rate of severe complications during labor "is an urgent public health issue" in the United States.
Alan Peaceman, a high-risk obstetrician at Northwestern Medicine who was not involved in the report, said, "The statistics presented are certainly disturbing, and in line with all the recent publicity surrounding this problem around the country." Peaceman noted that the report "does not determine … the causes of the increase in severe maternal morbidity," but said it could be linked to a "rise in the rate of cesarean sections," as well as "[p]atient changes," such as "increasing rates of obesity and diabetes, older maternal age, and use of infertility treatments."
Likewise, Andrew Satin, director of gynecology and obstetrics at Johns Hopkins Medicine, said there are likely a number of factors affecting maternal morbidity. "Older women are getting pregnant as well as women with pre-existing [medical] conditions," he said, adding that obesity also "is clearly a contributor." In addition, Satin said health care providers' "use of cesarean delivery really contributed to this," explaining, "When more women are having cesarean sections there's more risk for hemorrhage. And repeat cesarean sections create more risk for hemorrhage."
Satin added that hospitals can reduce the rates of maternal morbidity by implementing safety packages and guidelines that prepare providers for emergencies during delivery. For instance, Satin said hospitals "should have a hemorrhage cart that's stocked with the devices and medications commonly used" for hemorrhages. Satin said, "I believe we can do better and we should do better" (Carroll, Reuters, 9/5; Knowles, Becker's Clinical Leadership & Infection Control, 9/6; Ehley, "Pulse," Politico, 9/5).
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