Definition of acute SMM: severe, life threatening event during pregnancy & within 6 weeks of delivery. @NPEU_UKOSS provides UK wide high quality obstetric surveillance. Deaths, while uncommon, investigated in depth.
Study Aims: operationalise definition of SMM; report incidence… twitter.com/i/web/status/1…
Coding SMM in Scotland: diagnoses & procedures. Sepsis and esclampsia most frequent diagnoses; ICU admission & wound re-closure most common procedures. Peuperal sepsis leading cause of admission to any critical care facility. SMM incidence 50 per 1000 pregnancies. #OBAnes… twitter.com/i/web/status/1…
Risk factors for SMM: previous cesarean section, multiple gestation, African/ Middle East/ Asian descent, increased BMI, and pre-existing comorbidities have increased OR; parity protective? Increased SMM in recent years, more readily diagnosed or admitted to critical care? Or… twitter.com/i/web/status/1…
Short term outcomes of SMM: LoS >7 days, death, stillbirth, late second trimester loss. #OBAnes #OAA23ASM
Is coding accurate? Peuperal sepsis ICD-10 code. Definition closer to SMM: infection + organ dysfunction or peuperal sepsis + critical care admission. PPH excluded. #OBAnes #OAA23ASM
Media coverage - balanced? Key points: SMM as defined occurs in 1% of pregnancies. Definition requires refinement & validation. Risk factors for SMM increasing. SMM strongly linked to maternal death, stillbirth/ fetal loss, increase LoS. #OBAnes #OAA23ASM
Longer term outcomes. Consequences: PTSD, distrust of system. Surviving critical illness - post intensive care syndrome. Affects families and patients: mental health, cognitive and physical fall out —> quality of life impacts. #OBAnes #OAA23ASM
Study design. One-year mortality: 200 per 100,000 if admitted to ICU (2.5 per 100,000 if not). 42day readmission 26.7%, 42day to one-year readmission 14.1% (if admitted to ICU). Longer term outcomes: mortality, hospital readmission and NB psychiatric hospital admission.… twitter.com/i/web/status/1…
Implications. High emergency readmissions. Post ICU follow-up services ideal, but still patchy. Psychological support probably lacking. Maternity specific adaptations to existing services required? #OBAnes #OAA23ASM
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