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)