Overwhelming majority of US pregnancies, deliveries involve complications
MedWire News: A review of the most recently available data from the US Department of Health and Human Service's Agency for Healthcare Research and Quality (AHRQ) shows that the majority of US women experience complications during pregnancy and/or delivery.
Of the 4.2 million deliveries in the USA during 2008, 94.1% listed at least one type of pregnancy complication, and maternal stays in hospital were longer and more costly when complications were involved compared with when they were not, report the researchers.
"Complications during pregnancy can pose a serious risk to both maternal and infant health, and are associated with various outcomes, including miscarriage, hemorrhage, preterm labor, and low birth weight," write Ann Elixhauser (AHRQ Rockville, Maryland) and Lauren Wier (Thomson Reuters, Cambridge, Massachusetts).
The pair compiled a Statistical Brief using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample on pregnancy and childbirth hospitalizations during 2008. Part of the US Department of Health and Human Service's Healthy People 2020 project involves reducing maternal illness and complications relating to pregnancy and delivery in hospital, they explain.
In all, 4,673,700 pregnancy and delivery hospital stays were recorded among females aged 15-44 years during the study year. Among these, 473,700 stays were non-delivery ones, with complicating conditions as a principle or secondary diagnosis.
Compared with delivery stays in hospital without any complicating conditions, stays with complications were longer, at 2.7 days versus 1.9 days. Maternal stays without complications were also 50% less costly than those without, at US$2600 (€1796) versus $3900 (€2695) for delivery stays, and $4100 (€2833) for non-delivery stays.
For delivery stays, the most common complications that occurred at a rate of 100 or more per 1000 stays were umbilical cord complications (233 per 1000), perineal lacerations (158 1st degree, 168 2nd degree per 1000), and previous cesarean section (167 per 1000). The most common complication that occurred 50-99 times per hospital stay was hypertension, including eclampsia and pre-eclampsia, at 94 per 1000 stays.
The corresponding, most common complications for non-delivery stays were early or threatened labor (208 per 1000 stays), infections of the genitourinary tract (132 per 1000 stays), and hypertension including eclampsia and pre-eclampsia (113 per 1000). Anemia was the most common complication, occurring between 50-99 times per 1000 non-delivery hospital stays.
A very large number (493 and 433 for delivery and non-delivery per 1000 stays) of women experienced complications that were classed as "other complications of pregnancy" which include fatigue and insufficient weight gain, according to ICD-9-CM codes.
Finally, Elixhauser and Wier report that the average age of women who delivered with complicating conditions was approximately 2 years older than for women who delivered without, at 27.7 years versus 25.5 years. Furthermore, 15% of all stays with complications (with or without delivery) occurred among patients aged 35 to 44 years.
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By Sarah Guy