Postpartum Outcomes in BC

Study Overview
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Brief Summary
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For every case of maternal death, many more women experience life-threatening complications during pregnancy and childbirth. Yet, severe maternal morbidity (SMM) cases are often overlooked post-delivery. Women have reported that roughly 15% of SMM cases first occurred in the six weeks following delivery. The underlying factors associated with these morbidities are likely different than those occurring antenatally and at the time of delivery. Further research is required to elucidate the exact burden of SMM in the postpartum period in British Columbia (BC).

Detailed Description
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The ratio of maternal morbidity to maternal mortality is increasing globally (Geller 2018). In high-income countries, the World Health Organization (WHO) recommends routinely surveilling SMM to assess maternal health and quality of care (Geller 2018). To our knowledge, this is the first study conducted among pregnancies in BC aiming to examine the cumulative incidence, timing, and factors associated with postpartum maternal morbidity and hospital readmissions. This is a retrospective cohort study will use data from the BC Perinatal Data Registry (BCPDR), which contains maternal, fetal and neonatal health information from 99% of all deliveries in BC. The primary outcome assessed will be the cumulative incidence of hospital readmissions and SMM events occurring after delivery discharge within the first six weeks (42 days) of delivery. Secondary outcomes will include SMM-diagnosis, the rate and timing of postpartum SMM and readmissions, and maternal characteristics associated with these events. A multinominal logistic regression model will examine the association between postpartum SMM or readmission and determinants.

Official Title
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Assessment of Cumulative Incidence and Factors Associated With Hospital Re-admission and Severe Maternal Morbidity After Delivery Discharge in British Columbia

Conditions
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Morbidity;Perinatal, Pregnancy Complications, Pregnancy Related

Intervention / Treatment
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* Other: Retrospective database analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Delivered in BC from April 1, 2008 to March 31, 2021 Consented to data collected by the BCPDR Exclusion Criteria: • None

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Readmission/ SMM post-delivery discharge<br>All women aged 15-49 who were readmitted up to six weeks post-delivery discharge and/or experienced at least one SMM event up to six weeks post-delivery | Other: Retrospective database analysis<br>* This study will review data provided by the BCPDR from April 1, 2008 to March 31, 2021.<br>|
| De novo readmission/ SMM post-delivery discharge<br>All women aged 15-49 who were readmitted up to six weeks post-delivery discharge and/or experienced at least one SMM event post-delivery, excluding those who experienced a SMM in the two months before delivery or during delivery hospitalization | Other: Retrospective database analysis<br>* This study will review data provided by the BCPDR from April 1, 2008 to March 31, 2021.<br>|
| No post-delivery discharge readmission/ SMM at any time (CONTROL)<br>All women aged 15-49 who did not experience post-delivery discharge readmission and/or SMM at any time | Other: Retrospective database analysis<br>* This study will review data provided by the BCPDR from April 1, 2008 to March 31, 2021.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maternal hospital readmission | Cumulative incidence of women who get readmitted into the hospital after being discharged post-delivery | Up to six weeks post-delivery discharge | 
| Severe maternal morbidity (SMM) event | Cumulative incidence of women who experience least one SMM event, defined as: severe pre-eclampsia, HELLP, eclampsia; severe haemorrhage; maternal ICU admission; surgical complications; hysterectomy; sepsis; embolism, shock, DIC; assisted ventilation; cardiac conditions; acute renal failure; several uterine rupture; cerebrovascular accidents; and other types of maternal morbidity. | Up to six weeks post-delivery discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SMM type | Type of SMM event experienced | Up to six weeks postpartum | 
| Rate of hospital readmission and SMM events | Frequency of women who get readmitted to the hospital after discharge and/or experienced at least one SMM event | Up to six weeks postpartum | 
| Timing of hospital readmission and SMM events | Specific time frames for women who get readmitted to the hospital after discharge and/or experienced at least one SMM event | Up to six weeks postpartum | 
| Maternal characteristics | Characteristics associated with hospital readmission and SMM events after delivery discharge, such as age, race, geographic location, fetal outcome, mode of delivery and pre-existing maternal comorbidities (hypertension, diabetes, and mental health conditions). | Up to six weeks postpartum | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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postpartum period, severe maternal morbidity, hospital readmission