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Maternal Risk Conditions and Outcomes by Levels of Maternal Care
Carla L DeSisto1, Alexander C Ewing1, Hafsatou Diop2
1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Journal of Women'S Health (2002)
|October 25, 2024
Summary
Maternal risk conditions like severe preeclampsia and cardiac issues are linked to severe outcomes. Higher-level care facilities showed lower outcome risks for these conditions, supporting risk-appropriate care benefits.
Area of Science:
- Obstetrics and Gynecology
- Maternal Fetal Medicine
- Healthcare Quality Improvement
Background:
- Severe maternal morbidity poses significant risks.
- Identifying risk factors and care levels is crucial for improving outcomes.
- Risk-appropriate care aims to match patient acuity with facility capabilities.
Purpose of the Study:
- To determine associations between maternal risk conditions and severe adverse outcomes.
- To assess if these associations vary by hospital level of maternal care (LoMC).
Main Methods:
- Utilized the 2017-2019 National Inpatient Sample (NIS) for risk condition/outcome associations.
- Analyzed 2019 delivery data linked to hospital LoMC for stratified analysis.
- Examined severe preeclampsia, PAS, and cardiac conditions against outcomes like DIC, ARDS, and stroke.
Main Results:
- Positive associations found between maternal risk conditions and severe adverse outcomes.
- Outcomes like DIC, ARDS, and renal failure showed lower association magnitudes in Level III/IV facilities for severe preeclampsia/PAS.
- Cardiac conditions also showed lower outcome associations in higher-level facilities.
- 19.8-46.8% of high-risk patients delivered in
Conclusions:
- Higher-level maternal care facilities are associated with reduced odds of severe adverse outcomes for high-risk pregnancies.
- Findings support the benefit of risk-appropriate care models in obstetric settings.
- Ensuring access to higher-level care for at-risk populations is essential.
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