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Severe Obstetric Morbidity in the United States: 1998–2005

Kuklina, Elena V. MD, PhD; Meikle, Susan F. MD, MSPH; Jamieson, Denise J. MD, MPH; Whiteman, Maura K. PhD; Barfield, Wanda D. MD, MPH; Hillis, Susan D. PhD; Posner, Samuel F. PhD

doi: 10.1097/AOG.0b013e3181954e5b
Original Research

OBJECTIVE: To examine trends in the rates of severe obstetric complications and the potential contribution of changes in delivery mode and maternal characteristics to these trends.

METHODS: We performed a cross-sectional study of severe obstetric complications identified from the 1998–2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Logistic regression was used to examine the effect of changes in delivery mode and maternal characteristics on rates of severe obstetric complications.

RESULTS: The prevalence of delivery hospitalizations (per 1,000) complicated by at least one severe obstetric complication increased from 0.64% (n=48,645) in 1998–1999 to 0.81% (n=68,433) in 2004–2005. Rates of complications that increased significantly during the study period included renal failure by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57). In logistic regression models, adjustment for maternal age had no effect on the increased risk for these complications in 2004–2005 relative to 1998–1999. However, after adjustment for mode of delivery, the increased risks for these complications in 2004–2005 relative to 1998–1999 were no longer significant, with the exception of pulmonary embolism (odds ratio 1.30) and blood transfusion (odds ratio 1.72). Further adjustment for payer, multiple births, and select comorbidities had little effect.

CONCLUSION: Rates of severe obstetric complications increased from 1998–1999 to 2004–2005. For many of these complications, these increases were associated with the increasing rate of cesarean delivery.

LEVEL OF EVIDENCE: III

The increase in the rate of cesarean delivery in the United States is paralleled by increasing rates of severe obstetric complication codes among delivery hospitalizations.

From 1Quantell, Inc., Taneytown, Maryland; the 2Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; and the 3Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

The authors thank Pooja Bansil for programming assistance. The findings and conclusions in this report are those of the authors and do not necessarily represent the view of the Centers for Disease Control and Prevention or the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

Corresponding author: Susan Meikle, MD, MSPH, Medical Officer, CRHB/NICHD/NIH, 6100 Executive Boulevard, Suite 8B13C, Bethesda, MD 20892; email: meikles@mail.nih.gov.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.