Why pregnant women are admitted to intensive care in NZ

The first ever study of pregnant women in New Zealand with severe acute maternal morbidity (SAMM) found that 35% of those admitted to intensive care had a potentially preventable “near miss” event.

SAMM or a “near miss event” is ‘a very ill pregnant or recently delivered woman who would have died had it not been luck or good care was on her side.’ International research has found that 30-40% of severe acute maternal morbidity (SAMM) cases may be preventable.

The audit was carried out by a multi-disciplinary panel led by the University of Otago, Wellington and recently published in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

The authors point out the audit is indicative as it is a pilot study to look at the reasons for the ‘near miss’ for twenty-nine women and whether the events were potentially preventable. The women were admitted to the intensive care unit at Wellington Hospital in 2005-2007. One quarter of patients were admitted to Wellington from other District Health Boards.

Nevertheless lead researcher Dr Beverley Lawton says the study points to the need for a national audit of severe acute maternal morbidity so that obstetric services can be improved and fewer women suffer life threatening events.

“Negative outcomes associated with maternity care have considerable personal and public health costs,” she says. “We recommend that a national SAMM review process be introduced so that we may better understand issues around morbidity for pregnant women in New Zealand.”

The main reasons identified for ICU admission were: the need for intensive monitoring of the vital signs, low blood pressure, large volume blood loss and blood clotting, uncontrolled high blood pressure, and blood poisoning. Most of the women (25/29) were admitted to intensive care after they had given birth.

With those SAMM admissions that were potentially preventable, reasons ranged from: failure to diagnose infections such as blood poisoning, failure to follow up abnormal results, failure to recognize high risk of a life threatening event, delay in recognition of abnormal vital signs, delay in referral to experts and specialists, lack of knowledge, inadequate treatment and poor documentation. The majority of these reasons were provider- related issues where clinical care does not reach expected standards.

“These reasons are similar to overseas findings. They’re critically important as changes in provider behaviour should result in better outcomes for women, particularly early in any maternal complication,” says Dr Lawton.

All five women with blood poisoning were potentially preventable cases and the researchers suggest that this needs further investigation and education. In 2006 two of the six maternal deaths in New Zealand directly related to pregnancy were caused by blood poisoning.

Nine women in the study sample underwent emergency hysterectomy after giving birth, usually because of severe bleeding which failed to respond to other treatment.

Dr Lawton concludes that only by establishing a dedicated severe maternal monitoring system will New Zealand be able to closely follow the impact of changing reproductive trends and maternity services on women’s health, as well as identifying ‘near miss’ cases during pregnancy and birth.