Severe and acute maternal morbidity: Lithuanian experience and review.

Objective: To measure the incidence of severe acute maternal morbidity (SAMM) and to find the risk factors that could be useful in trying to predict the development of SAMM.

Methods: The data were collected prospectively in 7 maternity units from different Lithuanian regions over a 1-year period. Every woman with a clinical diagnosis of severe preeclampsia, eclampsia, Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome, severe hemorrhage, uterine rupture, or severe sepsis during pregnancy or delivery or until the 42nd day post partum was included after verification of diagnosis by using clinical criteria.

Result: One hundred and six cases of SAMM and one maternal death were identified during the study among 13,399 deliveries (7.91/1000 deliveries 95% CI 6.48-9.56). There were 57 cases of severe preeclampsia, 3 cases of eclampsia, 38 cases of severe hemorrhage, 3 cases of uterine rupture, and 4 cases of severe sepsis. One maternal death occurred due to HELLP syndrome, so the case-fatality ratio for severe morbidity was 0.99%.

Conclusions: The incidence of SAMM and case-fatality rate in Lithuania are similar to those in other European countries. The main risk factors for SAMM were previous peripartum hemorrhage, previous hypertension, previous renal diseases, lack of antenatal care, and dystocia.