Table 3. Comparing the rate of individual morbid events constituting the EMMOI with UK rates from published studies and rates of morbid events constitution the Australian indicator.
| Indicators included in the English MMOI | Codes | Number of women (Hospital Episode Statistics data) | Rate per 10,000 women giving birth (95% Cl), Hospital Episode Statistics data | Available incidence rates per 10,000 women giving birth (95% Cl)* in the UK from published studies and reports | Incidence of morbid events constituting the Australian indicator (Roberts et al, 2009)Rate/ 10,000 | Comparable with—the UK or Australian indicator or both/ Not comparable |
|---|---|---|---|---|---|---|
| Morbid events/ diagnosis (ICD-10 codes) | ||||||
| Acute abdomen | K35, K37, K65.0, K65.9, N73.3, N73.5 | 69 | 0.11 (0.01 to 0.14) | Not available | 0.36 | Comparable with the Australian indicator |
| Acute renal failure | O90.4, N17, N19, N99.0 | 518 | 0.81 (0.74 to 0.88) | Not available | 2.10 | Not comparable |
| Acute psychosis | F23, F53.1 | 340 | 0.53 (0.48 to 0.59) | 10 per 10,000 pregnant women in the UK [26] | 0.58 | Comparable with the Australian indicator |
| Cardiac arrest/ failure or infarction | O89.1, O74.2, O90.3, I21, I42, I43, I46, I50, J81 | 332 | 0.52 (0.47 to 0.58) | 0.33 per 10,000 pregnant women in the UK [27]. Myocardial infarction alone 0.07 per 10,000 maternities in the UK (95% CI 0.05 to 0.11) [28] | 4.49 | Comparable with the UK |
| Cerebral oedema or coma | G93.6, R40.2 | 91 | 0.14 (0.12 to 0.18) | Not available | Not reported | Not known |
| Disseminated Intravascular Coagulopathy | D65 | 70 | 0.11 (0.01 to 0.14) | Not available | Not reported | Not known |
| Cerebrovascular accident | I60, I61, I62, I63, I64 | 225 | 0.35 (0.31 to 0.40) | Antenatal stroke 0.15 per 10,000 maternities in the UK (95% CI 1.0 to 2.1) [29]. Postpartum stroke 0.16 per 10,000 maternities in the UK (95% CI 0.11 to 0.23) [29]. Overall 0.31 per 10,000 maternities in the UK (95% CI 0.24 to 0.40) [29] | 0.32 | Comparable with the UK and Australian indicator |
| Major complications of anaesthesia | O74.0, O74.1, O74.2, O74.3, O74.9, O89.0, O89.1, O89.2, O29.0, O29.1, O29.2 | 392 | 0.61 (0.55 to 0.68) | Serious non-fatal complications associated with extradural block 0.42 per 10,000 maternities in the UK (95% CI 0.34 to 0.51) [30]. Failed tracheal intubation 0.38 per 10,000 maternities in the UK (95% CI 0.29 to 0.49) [31]. Deaths due to anaesthetic complications in the UK in 2010–12 0.02 per 10,000 maternities in the UK (95% CI 0.01 to 0.04) [23] | 1.90 | Comparable with the UK |
| Obstetric embolism (including Amniotic Fluid Embolism) | O88 (O88.0, O88.1, O88.2, O88.3, O88.8) | 1742 | 2.73 (2.60 to 2.86) | Amniotic Fluid Embolism 0.17 per 10,000 maternities in the UK (95% CI 0.14 to 0.21) [32]. Antenatal pulmonary embolism 1.3 per 10,000 maternities in the UK (95% CI 1.1 to 1.5) [33]. Venous thromboembolism 8.5 per 10,000 maternities in a London hospital (95% CI 7.6 to 9.4) [34] | 3.88 | Not comparable |
| Shock | R57.0, R57.1, R57.2, R57.8, R57.9, O75.1, T80.5, T88.6 | 1252 | 1.96 (1.85 to 2.07) | Septic shock 0.91 per 10,000 maternities in the UK (95% CI 0.71–1.15). Incidence rates for septic shock in the UK were available from a UKOSS study that collected data from June 2011 to May 2012 [21]. Specific incidence of shock due to other complications during pregnancy and childbirth including those related to thromboembolism, AFE, etc could not be found. | 6.41 | Not comparable |
| Sickle cell anaemia with crisis | D57.0 | 291 | 0.46 (0.41 to 0.51) | 0.68 per 10,000 maternities in the UK (95% CI 0.51 to 0.88)—calculated from a UK wide epidemiological study by Oteng-Ntim et al., 2015 [35] | Not reported | Comparable with the UK |
| Status asthmaticus | J46 | 142 | 0.22 (0.19 to 0.26) | Not available | 0.42 | Comparable with the Australian indicator |
| Status epilepticus | G41, G41.0, G41.1, G41.2, G41.8, G41.9 | 173 | 0.27 (0.23 to 0.31) | Not available | 0.38 | Comparable with the Australian indicator |
| Uterine rupture | O71.0, O71.1 | 3077 | 4.82 (4.65 to 4.99) | 1.9 per 10,000 maternities in the UK (95% CI 1.6 to 2.2) [25] | 5.29 | Comparable with the Australian indicator |
| Eclampsia | O15.0, O15.1, O15.2, O15.9 | 4568 | 7.15 (6.94 to 7.36) | 2.7 per 10,000 births in the UK (95% CI 2.4 to 3.1) [22] | Not included in the Australian indicator | Not comparable |
| Sepsis | O85 | 2803 | 4.39 (4.23 to 4.55) | 4.7 per 10,000 maternities in the UK (95% CI 4.2–5.2) [21] | Not included in the Australian indicator | Comparable with the UK |
| Cerebral venous thrombosis | O87.3 | 16 | 0.03 (0.01 to 0.04) | Cerebral venous thrombosis 0.02 per 10,000 maternities in the UK (95% CI 0.003 to 0.04) [29] | Not included in the Australian indicator | Comparable with the UK |
| Procedures indicating morbidity (OPCS 4.7 codes) | ||||||
| Assisted ventilation including tracheostomy | E85.1, E85.2, E42.1, E42.2, E42.3, E42.8, E42.9 | 978 | 1.53 (1.44 to 1.63) | Not available | 2.64 | Not comparable |
| Curettage in combination with a general anaesthetic | R28.1 + Y80 | 78 | 0.12 (0.01 to 0.15) | Not available | 3.10 | Not comparable |
| Dialysis | X40, X41.1, X42.1 | 92 | 0.14 (0.11 to 0.18) | Not available | 0.34 | Comparable with the Australian indicator |
| Evacuation of haematoma | P09.3, P27.1, T34.1, T34.2, T34.3, T45.1, T45.2, T45.3, T45.4, Y22.1 | 3,186 | 4.99 (4.82 to 5.16) | Incidence rate not available, but 3 cases of haematoma/ abscess were noted in the study of non-fatal anaesthetic complications in the UK by Scott and Hibbard, 1990[30] | 6.11 | Not comparable |
| Hysterectomy | Q07.1, Q07.2, Q07.3, Q07.4, Q07.5, Q08 | 1,507 | 2.36 (2.24 to 2.48) | Emergency peripartum hysterectomy due to any cause 4.8 per 10,000 maternities in a London hospital (95% CI 2.7 to 8.0) [36]Peripartum hysterectomy for management of severe obstetric haemorrhage 3.6 per 10,000 maternities in a Nottingham hospital (95% CI 2.1 to 5.7) [37]. Peripartum hysterectomy for management of severe obstetric haemorrhage 3.8 per 10,000 maternities in the UK (95% CI 3.3 to 4.2) [38] | 3.12 | Comparable with the UK and Australian indicator |
| Procedures to reduce blood flow to uterus | L69.3, L69.4, L70.2, L70.3, L71.3, L93.3, L94.1, L94.6, L94.7, L99.1, L99.5, L99.6 | 390 | 0.61 (0.55 to 0.67) | 2nd line treatment for control of PPH (uterine compression sutures/ pelvic vessel ligation/ interventional radiology/ received rFVIIa). 2.2 per 10,000 maternities in the UK (95% CI 1.9 to 2.5) [39]. Rates recalculated after removing the 31 cases that received rFVIIa = 2.0 (95% CI 1.8 to 2.3) [39] | Embolisation or ligation of blood vessels = 0.80, Other interventions to control post-operative bleeding = 0.96 | Comparable with the Australian indicator |
| Re-closure of disrupted caesarean section wound | T28.3, T30.1, T30.2, T30.3, T30.4, S42.3, S42.4, S60.4 | 1989 | 3.11 (2.98 to 3.25) | Not available | 0.48 | Not comparable |
| Repair of bladder or cystostomy | M37.2, M37.3, M37.5, M37.8, M37.9, M38.2, M38.3, M73.6, M73.7 | 1,991 | 3.12 (2.98 to 3.26) | Accidental cystostomy rate in Aberdeen Maternity hospital 1.4 per 10,000 maternities (95% CI 0.8 to 2.2) [40] | Repair of bladder = 2.26, Cystostomy = 1.28 | Comparable with the Australian indicator |
| Repair of intestine | G58, G69, G70, G78, H06, H07, H08, H09, H10, H11, H23, H26, H29, H33, T37.4, T38.4, T42.1 | 48 | 0.008 (0.006 to 0.01) | Not available | 0.36 | Not comparable |
N = 6,389,066; *95% Confidence intervals are included where available. ICD-10: International Statistical Classification of Diseases and Related Health Problems—10th revision; OPCS: Classification of Interventions and Procedures, version 4.7 (April 2014)