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Updated: Sep 5, 2025

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Severe maternal morbidity in Scotland.

J A Masterson1, I Adamestam2, M Beatty3

  • 1Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, UK.

Anaesthesia
|July 12, 2022
PubMed
Summary

Severe maternal morbidity in Scotland increased significantly, with puerperal sepsis being a major factor. Older age, obesity, multiple pregnancies, and prior C-sections were linked to higher severe maternal morbidity risks.

Keywords:
maternal critical carerisk factorssevere maternal morbidity

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Epidemiology

Background:

  • Severe maternal morbidity poses a significant public health challenge.
  • Accurate measurement and identification of risk factors are crucial for improving maternal outcomes.
  • Previous studies may not fully capture the incidence and contributing factors of severe maternal morbidity.

Purpose of the Study:

  • To analyze the incidence and trends of severe maternal morbidity using a composite measure in Scotland over 14 years.
  • To identify demographic and clinical risk factors associated with severe maternal morbidity.
  • To assess the impact of severe maternal morbidity on hospital stay and mortality.

Main Methods:

  • A cohort study design was employed, analyzing pregnancies recorded over 14 years in Scotland.
  • A composite measure of severe maternal morbidity was defined using 17 diagnoses and 9 interventions, including critical care admission.
  • Statistical analysis included calculating incidence rates, odds ratios for risk factors, and comparing hospital stays and mortality rates.

Main Results:

  • Over 762,918 pregnancies, 7947 experienced severe maternal morbidity events, with puerperal sepsis being the most common (30%).
  • Incidence of severe maternal morbidity rose from 9 to 17 per 1000 pregnancies between 2012 and 2018, partly due to improved sepsis recording.
  • Risk factors included older maternal age, obesity, multiple pregnancies, and previous caesarean delivery. Mortality rates were substantially higher for women with severe maternal morbidity.

Conclusions:

  • The incidence of severe maternal morbidity in Scotland is higher than previously reported, potentially influenced by coding practices for conditions like puerperal sepsis.
  • Older maternal age, obesity, multiple pregnancies, and prior C-sections are significant risk factors for severe maternal morbidity.
  • The study highlights the substantial impact of severe maternal morbidity on healthcare utilization and mortality, underscoring the need for effective prevention and management strategies.