Poster Session 2
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor
Cleveland Clinic Lerner College of Medicine
Cleveland, Ohio, United States
Megan R. Ansbro, MD, PhD
Resident Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Antonio Bajan, BS
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Elizabeth Raiff, MPH
Research Program Manager
Cleveland Clinic Ob/Gyn & Women’s Health Institute
Cleveland, Ohio, United States
Justin R. Lappen, MD
Division Director - Maternal Fetal Medicine
Associate Professor - Obstetrics/Gynecology and Reproductive Biology
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland Clinic
Cleveland, Ohio, United States
Severe maternal morbidity (SMM) encompasses a diversity of adverse maternal medical outcomes that may be differentially triggered in patients with different risk profiles. This study evaluates incidence of component indicators of SMM by OBCMI level.
Study Design:
This is a retrospective study of all deliveries > 20 weeks across a multi-hospital academic health system from 1/1/2022-6/30/2024. Patient clinical information was extracted from the electronic health record and OBCMI scores were constructed based on risk factors present at delivery and divided into brackets of low risk (0-2), medium risk (3-5), and high risk (>6) based on score distribution. Patient characteristics including OBCMI components and delivery admission SMM indicator variables were compared across brackets in univariable analysis using chi2.
Results:
28,812 deliveries were included: 67.4% with scores 0-2, 21.0% with scores 3-5, and 11.5% with scores > 6. There were significant differences in the incidence of each OBCMI component by score bracket (Table 1). Cardiomyopathy and pulmonary hypertension were the only comorbidities present exclusively in the highest risk bracket. Table 2 demonstrates the overall incidence of SMM by group: 0.5% in the lowest, 2.5% in the medium, and 8.1% in the highest risk bracket. Renal failure was the most common SMM indicator for all brackets, followed by disseminated intravascular coagulation in the 2 highest risk brackets and sepsis in the lowest risk bracket. Eclampsia co-ranked as second most frequent SMM indicator in the highest risk bracket. Incidence of each SMM indicator across brackets was significantly different for all except ruptured aneurysm and vaso-occlusive crisis.
Conclusion:
SMM sub-types occur at different relative frequencies across patient groups with different co-morbidity-based risk. Understanding these differences can shape patient counseling as well as target specific interventions to prevent sub-types of SMM.
