XXXX : an Australian-New Zealand population-based study.

@entity1 @entity1003 @entity519 @entity6703 @entity1167 @entity551
BACKGROUND: @entity6703 ( @entity6703 ) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of @entity6703 in either country. The aim of this study was to estimate the incidence of @entity6703 in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes. METHODS: A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96  % of @entity1 giving birth in Australia and all 24 New Zealand maternity units (100  % of @entity1 giving birth in hospitals) between January 1 2010-December 31 2011. A case of @entity6703 was defined either as a clinical diagnosis (acute @entity551 or @entity1167 , acute @entity519 and @entity1003 in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation). RESULTS: Thirty-three cases of @entity6703 were reported from an estimated cohort of 613,731 @entity1 giving birth, with an estimated incidence of 5.4 cases per 100   000 @entity1 giving birth (95  % CI 3.5 to 7.2 per 100   000). Two (6  %) events occurred at home whilst 46  % (n   =   15) occurred in the birth suite and 46  % (n   =   15) in the operating theatre (location not reported in one case). Fourteen @entity1 (42  %) underwent either an induction or augmentation of labour and 22 (67  %) underwent a caesarean section. Eight @entity1 (24  %) conceived using assisted reproduction technology. Thirteen (42  %) @entity1 required cardiopulmonary resuscitation, 18  % (n   =   6) had a hysterectomy and 85  % (n   =   28) received a transfusion of blood or blood products. Twenty (61  %) were admitted to an Intensive Care Unit (ICU), eight (24  %) were admitted to a High Dependency Unit (HDU) and seven (21  %) were transferred to another hospital for further management. Five @entity1 died (case fatality rate 15  %) giving an estimated maternal mortality rate due to @entity6703 of 0.8 per 100   000 @entity1 giving birth (95  % CI 0.1  % to 1.5  %). There were two deaths among 36 @entity1 . CONCLUSIONS: A coordinated emergency response requiring resource intense multi-disciplinary input is required in the management of @entity1 with @entity6703 . Although the case fatality rate is lower than in previously published studies, high rates of hysterectomy, resuscitation, and admission to higher care settings reflect the significant morbidity associated with @entity6703 . Active, ongoing surveillance to document the risk factors and short and long-term outcomes of @entity1 and their babies following @entity6703 may be helpful to guide best practice, management, counselling and service planning. A potential link between @entity6703 and assisted reproductive technology warrants further investigation.
