The first national audit of severe medical complications during pregnancy has found that such complications are ‘disproportionately higher' among women from ethnic minorities.

The audit was carried out by the National Perinatal Epidemiology Centre (NPEC) based in University College Cork (UCC) and looked at the year 2011. It took in 19 of the country's 20 maternity units, totaling over 67, 800 maternities - live births and stillbirths. This represents 93% of all pregnancies in Ireland in 2011.

The audit found that one in every 263 women experienced a severe maternal medical complication. Among these, almost six in 10 were diagnosed with one complication, while one in three were diagnosed with two. A small number was diagnosed with three or more complications.

However, the audit noted that ‘the incidence of severe maternal morbidities (complications) was disproportionately higher among ethnic minorities'.

The most commonly recorded severe complication was major obstetric haemorrhage. This was defined as an estimated blood loss of more than 2,500ml and /or a transfusion of more than five units of blood and/or treatment for coagulopathy (clotting disorder). The reported rate of this complication was 2.3 per 1,000 maternities.

The next most commonly recorded complications were intensive care unit admission, renal/liver dysfunction and peripartum hysterectomy.

Peripartum hysterectomy is a procedure performed most often as an emergency to save the life of a woman with persistent bleeding, or as a planned procedure to treat cancer associated with a pregnancy.

The rate of peripartum hysterectomy was 0.3 per 1,000 maternities. Most of those who required this procedure had suffered a major obstetric haemorrhage.

Meanwhile, the rate of eclampsia, which is seizures associated with pregnancy-related high blood pressure, was 0.2 per 1,000 maternities, while the rate of septic shock was 0.06 per 1,000 maternities. This is in line with international findings.

Commenting on the audit, NPEC director, Prof Richard Greene, insisted that the findings ‘highlight the high quality of maternity care in Ireland when benchmarked internationally'.

"Patients should be reassured by the findings and especially by the commitment of the service to reviewing outcomes with a view to enhancing the quality of care and patient safety," he said.

Meanwhile, according to Dr Philip Crowley, national director of quality and patient safety with the HSE, this audit, ‘will inform how we guide and support our obstetric services to continually improve the quality of care that they provide to women'.

"While the results suggest our services provide care that compares well with other jurisdictions, they also provide guidance for how we must continually improve that care," he added.

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