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Maternal and Infant Health: Maternal Morbidity in a Managed Care
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The Extent of Maternal Morbidity in a
Managed Care Setting
Although 6 million women become pregnant each year, little is known about
the extent of antepartum, intrapartum, and postpartum morbidity. Previous
studies have been limited to measuring hospitalizations as a proxy for
complications for individual women. These data do not account for multiple
hospitalizations per woman, nor do they consider morbidity occurring during
the delivery hospitalization or postpartum. Further, because of changes in
the health care system and trends in the management of many conditions,
treatment of pregnancy-related complications in an outpatient setting is
increasing. Current data do not permit accurate measurement of the incidence
and prevalence of the full spectrum of maternal morbidity.
In 1992,
National Hospital Discharge Survey (NHDS) data for 1986 and 1987
indicated that 22.2 antenatal hospitalizations occurred per 100
deliveries. This estimate was updated in 1998 using 1991 and 1992 NHDS data
and the ratio was 16.7 hospitalizations per 100 deliveries. The most recent
estimate for 1999–2000 is 12.8 hospitalizations per 100 deliveries. In spite
of the trend of decreasing hospitalizations during pregnancy prior to
delivery, there is little evidence to suggest that overall maternal
morbidity is decreasing. None of these estimates take into account women
with complications who were not hospitalized or women with postpartum
complications; therefore, they underestimate the true magnitude of maternal
morbidity. Potential reductions in maternal morbidity depend on a greater
understanding of their etiologies and patterns.
Scientists in DRH are collaborating with researchers
in a large managed care organization to conduct a comprehensive examination
of complications related to pregnancy. The data will provide a considerable
advance in information needed to study causes of pregnancy complications,
detect differences in complications over time, and evaluate effects of
changes in care practices. The prevalence of antepartum, intrapartum, and
postpartum morbidities among women in this health care system will be
determined. In the future, the methodology developed in this study can be
applied to an expanded database and in-depth studies of maternal morbidity
may be possible. In addition, these methods can be used to establish
ongoing surveillance of maternal morbidities, enabling early detection of
sentinel events among pregnant women and identification of trends in
morbidities related to behavioral and environmental risks.
Division of Reproductive Health's Maternal Health, Infant
Health, and Preterm Delivery
In the United States each year, approximately six million women become
pregnant. While most women have a normal term pregnancy and deliver a normal
infant, a safe and healthy pregnancy is not the experience of all women
...more
Date last reviewed:
05/19/2006
Content source: Division
of Reproductive Health,
National Center for Chronic
Disease Prevention and Health Promotion |
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