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Obstetric near misses among women with serious mental illness: data linkage cohort study

BACKGROUND: Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. AIMS: To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). METHOD: We conducted a h...

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Detalles Bibliográficos
Autores principales: Easter, Abigail, Sandall, Jane, Howard, Louise M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387856/
https://www.ncbi.nlm.nih.gov/pubmed/33427147
http://dx.doi.org/10.1192/bjp.2020.250
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author Easter, Abigail
Sandall, Jane
Howard, Louise M.
author_facet Easter, Abigail
Sandall, Jane
Howard, Louise M.
author_sort Easter, Abigail
collection PubMed
description BACKGROUND: Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. AIMS: To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). METHOD: We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort – all women with a live or still birth in 2007–2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort – all women with a live or still birth in 2007–2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). RESULTS: The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2–1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0–607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3–2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1–3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1–4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6–5.8, P < 0.001). CONCLUSIONS: Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.
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spelling pubmed-83878562021-09-01 Obstetric near misses among women with serious mental illness: data linkage cohort study Easter, Abigail Sandall, Jane Howard, Louise M. Br J Psychiatry Paper BACKGROUND: Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. AIMS: To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). METHOD: We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort – all women with a live or still birth in 2007–2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort – all women with a live or still birth in 2007–2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). RESULTS: The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2–1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0–607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3–2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1–3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1–4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6–5.8, P < 0.001). CONCLUSIONS: Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI. Cambridge University Press 2021-09 /pmc/articles/PMC8387856/ /pubmed/33427147 http://dx.doi.org/10.1192/bjp.2020.250 Text en © The Authors 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Paper
Easter, Abigail
Sandall, Jane
Howard, Louise M.
Obstetric near misses among women with serious mental illness: data linkage cohort study
title Obstetric near misses among women with serious mental illness: data linkage cohort study
title_full Obstetric near misses among women with serious mental illness: data linkage cohort study
title_fullStr Obstetric near misses among women with serious mental illness: data linkage cohort study
title_full_unstemmed Obstetric near misses among women with serious mental illness: data linkage cohort study
title_short Obstetric near misses among women with serious mental illness: data linkage cohort study
title_sort obstetric near misses among women with serious mental illness: data linkage cohort study
topic Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387856/
https://www.ncbi.nlm.nih.gov/pubmed/33427147
http://dx.doi.org/10.1192/bjp.2020.250
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