Incidence and predictors of severe obstetric morbidity: case-control studyCommentary: Obstetric morbidity data and the need to evaluate thromboembolic disease
Given their comments about the small size of previous studies, we are
very surprised that the authors of the paper on severe obstetric
morbidity1 did not mention that it was undertaken as part of an European
Union Concerted Action on Maternal Mortality and Severe Morbidity (MOMS).
Although they ‘ searched Medline using key words’ and ‘selected
definitions that were clinically based and routinely measurable and that
did not include management process.’, the definitions they used were, not
surprisingly the same as those used by other participants in our European
collaborative study. These were published in our final report2 and are
appended. They were developed by the participants at meetings which two of
the authors attended.
As they state, at the outset, there was no agreed definition of
severe maternal morbidity. The project leader had proposed a definition
previously used in a French survey on intensive care admissions of
obstetric patients.3 The group rejected this for the reasons stated in
the author’s paper1 and instead developed an approach based on three major
conditions which can lead to mortality, haemorrhage, eclampsia and
infections. The definition of severe hemorrhage has been used in a French
evaluation of quality of obstetric care, which is currently in press. 4
The agreed definitions were then used, not only by the authors, but
also in ten other simultaneous population-based studies in regions within
countries of Europe in order to compare rates of severe maternal
morbidity. As four of the surveys were small, we have given aggregated
totals for the three conditions in Table 1. Major differences were seen in
incidence and these form an important baseline for future investigations
of possible factors which could have led to them.
Although the authors’ survey was the largest, sizeable surveys were
done in Belgium, Finland and France. It is a pity that they did not
consider the collaboration, their involvement in it and the contribution
made by collaborators to the development of the indicators they used
worthy of mention in their paper.
Sophie ALEXANDER coordinator for MOMS-B survey and
Marie-Hélène
Bouvier-Colle, Past project leader of the MOMS surveys.
References
1- Waterstone M, Bewley S, Wolfe C. “ Incidence and predictors of severe
obstetric morbidity : case-control study. BMJ 2001, 322 : 1089-92
2-(MH Bouvier-Colle for the MOMS group ) Frequency and risk factors of
maternal morbidity and mortality- avoidable diseases and evaluation of
care- MOMS . Final report (Contract n° MMH1-CT93-1064 & (PECO) CIPD-
CT94-0279) 6 avril 1998.
3- Bouvier-Colle MH, Varnoux N, Salanave B, Ancel PY, Bréart G and the
maternal morbidity group. Case-control study of risk factors for obstetric
patients’ admission to Intensive care units. Eur J Obstet Gynecol Reprod
Biol 1997 ; 74 : 173-77.
4- Bouvier-Colle MH, Ould El Joud D, Varnoux N, Goffinet F, and the study
group of haemorrhages. Evaluation of care for severe obstetric
haemorrhages in three French Regions. BJOG in press
Table 1 Incidence of severe obstetric morbidity in 11 regions in
Europe , by main obstetrical complications, according to the MOMS-B
Survey.
Incidence per 1000
European Regions Number of cases of severe morbidity Births or deliveries
TOTAL Severe PET HAEMOR-RHAGE SEPSIS
UK, South East Thames 608 48 262 12,6 5,0 7,3 0,3
Austria 36 6 022 6,0 5,3 - -
Belgium 272 17 500 15,5 5,9 5,9 3,6
Finland 263 17 249 15,3 4,9 9,0 1,3
Hungary, Budapest area 117 13 667 8,6 5,8 2,3 0,4
Irland 11 1 800 6,1 5,0 - -
Italia 23 3 170 7,2 6,0 - -
Norway 27 3 010 8,9 2,3 2,6 4,0
France, Champagne-Ard. 113 16 806 6,7 2,4 3,1 1,1
France, Centre 149 27 231 5,5 2,4 2,7 0,3
France, Lorraine 224 27 872 8,0 3,7 3,9 0,4
TOTAL 1843 182 589 10,1 4,3 4,9 0,9
Competing interests:
Table 1 Incidence of severe obstetric morbidity in 11 regions in Europe , by main obstetrical complications, according to the MOMS-B Survey.Incidence per 1000 European Regions Number of cases of severe morbidity Births or deliveries TOTAL Severe PET HAEMOR-RHAGE SEPSISUK, South East Thames 608 48 262 12,6 5,0 7,3 0,3Austria 36 6 022 6,0 5,3 - -Belgium 272 17 500 15,5 5,9 5,9 3,6Finland 263 17 249 15,3 4,9 9,0 1,3Hungary, Budapest area 117 13 667 8,6 5,8 2,3 0,4Irland 11 1 800 6,1 5,0 - -Italia 23 3 170 7,2 6,0 - -Norway 27 3 010 8,9 2,3 2,6 4,0France, Champagne-Ard. 113 16 806 6,7 2,4 3,1 1,1France, Centre 149 27 231 5,5 2,4 2,7 0,3France, Lorraine 224 27 872 8,0 3,7 3,9 0,4TOTAL 1843 182 589 10,1 4,3 4,9 0,9
Rapid Response:
Severe maternal morbidity in Europe
Given their comments about the small size of previous studies, we are
very surprised that the authors of the paper on severe obstetric
morbidity1 did not mention that it was undertaken as part of an European
Union Concerted Action on Maternal Mortality and Severe Morbidity (MOMS).
Although they ‘ searched Medline using key words’ and ‘selected
definitions that were clinically based and routinely measurable and that
did not include management process.’, the definitions they used were, not
surprisingly the same as those used by other participants in our European
collaborative study. These were published in our final report2 and are
appended. They were developed by the participants at meetings which two of
the authors attended.
As they state, at the outset, there was no agreed definition of
severe maternal morbidity. The project leader had proposed a definition
previously used in a French survey on intensive care admissions of
obstetric patients.3 The group rejected this for the reasons stated in
the author’s paper1 and instead developed an approach based on three major
conditions which can lead to mortality, haemorrhage, eclampsia and
infections. The definition of severe hemorrhage has been used in a French
evaluation of quality of obstetric care, which is currently in press. 4
The agreed definitions were then used, not only by the authors, but
also in ten other simultaneous population-based studies in regions within
countries of Europe in order to compare rates of severe maternal
morbidity. As four of the surveys were small, we have given aggregated
totals for the three conditions in Table 1. Major differences were seen in
incidence and these form an important baseline for future investigations
of possible factors which could have led to them.
Although the authors’ survey was the largest, sizeable surveys were
done in Belgium, Finland and France. It is a pity that they did not
consider the collaboration, their involvement in it and the contribution
made by collaborators to the development of the indicators they used
worthy of mention in their paper.
Sophie ALEXANDER
coordinator for MOMS-B survey and
Marie-Hélène
Bouvier-Colle,
Past project leader of the MOMS surveys.
References
1- Waterstone M, Bewley S, Wolfe C. “ Incidence and predictors of severe
obstetric morbidity : case-control study. BMJ 2001, 322 : 1089-92
2-(MH Bouvier-Colle for the MOMS group ) Frequency and risk factors of
maternal morbidity and mortality- avoidable diseases and evaluation of
care- MOMS . Final report (Contract n° MMH1-CT93-1064 & (PECO) CIPD-
CT94-0279) 6 avril 1998.
3- Bouvier-Colle MH, Varnoux N, Salanave B, Ancel PY, Bréart G and the
maternal morbidity group. Case-control study of risk factors for obstetric
patients’ admission to Intensive care units. Eur J Obstet Gynecol Reprod
Biol 1997 ; 74 : 173-77.
4- Bouvier-Colle MH, Ould El Joud D, Varnoux N, Goffinet F, and the study
group of haemorrhages. Evaluation of care for severe obstetric
haemorrhages in three French Regions. BJOG in press
Competing interests: Table 1 Incidence of severe obstetric morbidity in 11 regions in Europe , by main obstetrical complications, according to the MOMS-B Survey.Incidence per 1000 European Regions Number of cases of severe morbidity Births or deliveries TOTAL Severe PET HAEMOR-RHAGE SEPSISUK, South East Thames 608 48 262 12,6 5,0 7,3 0,3Austria 36 6 022 6,0 5,3 - -Belgium 272 17 500 15,5 5,9 5,9 3,6Finland 263 17 249 15,3 4,9 9,0 1,3Hungary, Budapest area 117 13 667 8,6 5,8 2,3 0,4Irland 11 1 800 6,1 5,0 - -Italia 23 3 170 7,2 6,0 - -Norway 27 3 010 8,9 2,3 2,6 4,0France, Champagne-Ard. 113 16 806 6,7 2,4 3,1 1,1France, Centre 149 27 231 5,5 2,4 2,7 0,3France, Lorraine 224 27 872 8,0 3,7 3,9 0,4TOTAL 1843 182 589 10,1 4,3 4,9 0,9