Postpartum Outcomes in BC

• Conditions: Morbidity;Perinatal; Pregnancy Related; Pregnancy Complications
• Interventions: Other: Retrospective database analysis

• Registration Number: NCT05461183
• Lead Sponsor: University of British Columbia

Brief Summary

For every case of maternal death, many more women experience life-threatening complications during pregnancy and childbirth. Yet, severe maternal morbidity (SMM) cases are often overlooked post-delivery. Women have reported that roughly 15% of SMM cases first occurred in the six weeks following delivery. The underlying factors associated with these morbidities are likely different than those occurring antenatally and at the time of delivery. Further research is required to elucidate the exact burden of SMM in the postpartum period in British Columbia (BC).

Detailed Description

The ratio of maternal morbidity to maternal mortality is increasing globally (Geller 2018). In high-income countries, the World Health Organization (WHO) recommends routinely surveilling SMM to assess maternal health and quality of care (Geller 2018). To our knowledge, this is the first study conducted among pregnancies in BC aiming to examine the cumulative incidence, timing, and factors associated with postpartum maternal morbidity and hospital readmissions.

This is a retrospective cohort study will use data from the BC Perinatal Data Registry (BCPDR), which contains maternal, fetal and neonatal health information from 99% of all deliveries in BC. The primary outcome assessed will be the cumulative incidence of hospital readmissions and SMM events occurring after delivery discharge within the first six weeks (42 days) of delivery. Secondary outcomes will include SMM-diagnosis, the rate and timing of postpartum SMM and readmissions, and maternal characteristics associated with these events. A multinominal logistic regression model will examine the association between postpartum SMM or readmission and determinants.

Study Timeline

• Study Start: 2008-04-01
• Primary Completion: 2021-03-31
• Status Verified: 2022-07
• Study First Submitted: 2022-07-13
• Study First Submitted QC: 2022-07-13
• Last Update Submitted: 2022-07-13
• Study First Posted: 2022-07-18
• Last Update Posted: 2022-07-18
• Study Completion: 2023-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Female
• Target Recruitment: 15000

Inclusion Criteria

• Delivered in BC from April 1, 2008 to March 31, 2021
• Consented to data collected by the BCPDR

Exclusion Criteria

• None

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Readmission/ SMM post-delivery discharge	Retrospective database analysis	All women aged 15-49 who were readmitted up to six weeks post-delivery discharge and/or experienced at least one SMM event up to six weeks post-delivery
No post-delivery discharge readmission/ SMM at any time (CONTROL)	Retrospective database analysis	All women aged 15-49 who did not experience post-delivery discharge readmission and/or SMM at any time
De novo readmission/ SMM post-delivery discharge	Retrospective database analysis	All women aged 15-49 who were readmitted up to six weeks post-delivery discharge and/or experienced at least one SMM event post-delivery, excluding those who experienced a SMM in the two months before delivery or during delivery hospitalization

Primary Outcome Measures

Name	Time	Method
Maternal hospital readmission	Up to six weeks post-delivery discharge	Cumulative incidence of women who get readmitted into the hospital after being discharged post-delivery
Severe maternal morbidity (SMM) event	Up to six weeks post-delivery discharge	Cumulative incidence of women who experience least one SMM event, defined as: severe pre-eclampsia, HELLP, eclampsia; severe haemorrhage; maternal ICU admission; surgical complications; hysterectomy; sepsis; embolism, shock, DIC; assisted ventilation; cardiac conditions; acute renal failure; several uterine rupture; cerebrovascular accidents; and other types of maternal morbidity.

Secondary Outcome Measures

Name	Time	Method
Timing of hospital readmission and SMM events	Up to six weeks postpartum	Specific time frames for women who get readmitted to the hospital after discharge and/or experienced at least one SMM event
SMM type	Up to six weeks postpartum	Type of SMM event experienced
Rate of hospital readmission and SMM events	Up to six weeks postpartum	Frequency of women who get readmitted to the hospital after discharge and/or experienced at least one SMM event
Maternal characteristics	Up to six weeks postpartum	Characteristics associated with hospital readmission and SMM events after delivery discharge, such as age, race, geographic location, fetal outcome, mode of delivery and pre-existing maternal comorbidities (hypertension, diabetes, and mental health conditions).