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833: Severe maternal morbidity associated with hypertensive disorders of pregnancy after regionalization of perinatal care in New York City
Abstract   Open access   Peer reviewed

833: Severe maternal morbidity associated with hypertensive disorders of pregnancy after regionalization of perinatal care in New York City

Christina Ackerman, Christian Pettker, Dena Goffman, Katherine Campbell, Marissa Platner, Xiao Zu, Sonya Abdel-Razeq, Sophie Chung and Heather S. Lipkind
American journal of obstetrics and gynecology, Vol.218(1 Suppl), pp.S496-S496
01/03/2018
DOI: 10.1016/j.ajog.2017.11.366
url
https://doi.org/10.1016/j.ajog.2017.11.366View
Published (Version of record) Open Access

Abstract

Objective Severe maternal morbidity as defined by the CDC (CDC-SMM) is increasing. In 2003, the New York State Department of Health developed a Regional Perinatal Center (RPC) model, which categorized all hospitals for each designated level of perinatal care and promoted regional perinatal partnerships to improve birth outcomes. While it is known that hypertensive disorders of pregnancy (HDP) are associated with CDC-SMM, the relationship with levels of maternal care is unclear. This study evaluated the impact of RPC on CDC-SMM during delivery hospitalization among women with HDP. Study Design In this retrospective cohort study of women, 15-55 years old with a singleton gestation between 2008-12 in New York City (NYC), we examined the risk of CDC-SMM in women with HDP compared to normotensive controls. CDC-SMM rates were stratified by delivery hospital’s level of care. CDC-SMM was identified by linked birth certificate and hospital discharge data. Levels of care were designated per ACOG/SMFM Obstetric Care Consensus. With multivariable logistic regression, we assessed the odds of CDC-SMM in hypertensive versus normotensive women during the delivery hospitalization for each level of perinatal care. Models were adjusted for relevant sociodemographic and pregnancy-specific variables and chronic medical conditions. Results 574,565 women met inclusion criteria, with 41,713 (7.26%) having HDP. When compared to normotensive controls, women with HDP who delivered at a level 2 hospital had the highest odds of CDC-SMM during the delivery hospitalization, adjusted odds ratio (aOR) 4.21 (95% CI, 3.63-4.89). Women with HDP who delivered at a RPC had the lowest odds of CDC-SMM, aOR 1.86 (95% CI 1.74-1.99). When assessing the risk for CDC-SMM excluding transfusions, the adjusted odds ratio trend was conserved. (Table 1). Conclusion Compared to controls and stratified for level of care, women with HDP have the highest increased odds of CDC-SMM when cared for at facilities with lower level of care designations. Further analysis can inform clinical guidelines to determine which patients require timely transfer to an RPC and also aid in development of coordinated treatment protocols for HDP at lower levels of care. Utilization of the NYC RPC model for levels of perinatal care may significantly decrease severe maternal morbidity across the nation.

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