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Q&A

Obstetric Quality and Safety

Poster Session 2

(494) Developing a Novel Patient-Centered Definition of Severe Maternal Morbidity

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Existing frameworks for severe maternal morbidity (SMM) do not account for how patients perceive and experience SMM. This study evaluated patient values and perceptions related to maternal complications with the goal of devising a patient-centered SMM composite.

Study Design:

This 2-part sequential qualitative to quantitative mixed-methods study first involved structured interviews of postpartum patients recruited from an urban, academic hospital with purposive sampling by race and mode of delivery. Qualitative data around patient-perceived adverse maternal events were analyzed thematically. Second, potential adverse maternal events derived from this interview data as well as established SMM criteria were evaluated in a survey which prompted ranking on a scale from 1 [“no big deal”]-5 [“worst thing imaginable”]. All postpartum patients were eligible to participate and completed the survey prior to discharge (from 6/2022-11/2022).

Results:

18 patient interviews identified 9 themes distinct from established SMM criteria. 501 patients then participated in the survey study (60.7% Black, 6.5% Hispanic, median maternal age 31 [IQR 26-34], 40.6% had cesarean delivery, 6% had hemorrhage, and 1.6% had SMM without transfusion [CDC definition]). Patient rankings of potential SMM components are displayed in the Table. The 3 highest ranked outcomes were stroke/seizure, hysterectomy, and heart failure. 66.3% of patients ranked severe postpartum depression as a 4 or 5, higher than hemorrhage, transfusion, and long-term physical disability, and > 25% ranked readmission (32.5%) and unplanned cesarean (25.7%) as 5/5.

Conclusion: Adverse maternal outcomes important to patients do not correlate directly with established SMM composites. Incorporating expanded maternal morbidity criteria –such as unplanned cesarean and postpartum depression –into research and intervention frameworks is important in order to take a patient-centered approach to evaluating and mitigating SMM.