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Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California

Wall-Wieler, Elizabeth PhD; Carmichael, Suzan L. PhD; Gibbs, Ronald S. MD; Lyell, Deirdre J. MD; Girsen, Anna I. MD, PhD; El-Sayed, Yasser Y. MD; Butwick, Alexander J. FRCA, MS

doi: 10.1097/AOG.0000000000003370
Contents: Maternal Morbidity and Mortality: Original Research
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OBJECTIVE: To assess the prevalence and risk of severe maternal morbidity among delivery hospitalization for stillbirth compared with live birth deliveries.

METHODS: Using data from the Office of Statewide Health Planning and Development in California, we performed a population-based cross-sectional study of 6,459,842 deliveries between 1999 and 2011. We identified severe maternal morbidity using an algorithm comprising diagnoses and procedures developed by the Centers for Disease Control and Prevention and used log-binomial regression models to examine the relative risk (RR) of severe maternal morbidity for stillbirth compared with live birth deliveries, adjusting for maternal demographic, medical, and obstetric characteristics. We also examined severe maternal morbidity prevalence by cause of fetal death among stillbirth deliveries.

RESULTS: The prevalence of severe maternal morbidity for stillbirth and live birth was 578 and 99 cases per 10,000 deliveries, respectively. After adjusting for maternal demographic, medical, and obstetric characteristics, the risk of severe maternal morbidity among stillbirth deliveries was more than fourfold higher (adjusted RR 4.77; 95% CI 4.53–5.02) compared with live birth deliveries. The severe maternal morbidity prevalence was highest among stillbirths caused by hypertensive disorders and placental conditions (24 and 19 cases/100 deliveries, respectively), and lowest among stillbirths caused by fetal malformations or genetic abnormalities (1 case per 100 deliveries).

CONCLUSION: Women who have stillbirths are at substantially higher risk for severe maternal morbidity than women who have live births, regardless of cause of fetal death. The prevalence of severe maternal morbidity varies by cause of fetal death.

Women who have stillbirths are at substantially higher risk for severe maternal morbidity than women who have live births.

Departments of Pediatrics, Obstetrics and Gynecology, and Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.

Corresponding author: Elizabeth Wall-Wieler, PhD, Stanford, CA; email: ewallwie@stanford.edu.

This work was supported by the National Institutes of Health (NR017020 and HD095034) and the Department of Anesthesiology, Perioperative, and Pain Medicine, and the Department of Obstetrics and Gynecology, Stanford University School of Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Financial Disclosure Ronald S. Gibbs has received money from Novavax/ACI. Alexander J. Butwick has received money from Cerus Corporation and Instrumentation Laboratory. The other authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B447.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.