Extending the duration of monitoring for severe pregnancy complications shows that traditional delivery-focused monitoring misses more than 40% of cases, according to a new study published in . CMJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251425 This extended monitoring from pregnancy to 6 weeks postpartum.
Severe maternal morbidity (SMM) refers to complications during pregnancy that can cause death, prolonged hospitalization, or long-term disability. Current practice in Canada is to monitor and report cases of SMM during labor and delivery, but evidence suggests that extending the surveillance period from pregnancy to 6 weeks postpartum may be beneficial and consistent with World Health Organization guidance.
These findings are consistent with Ontario coroner’s data showing that most maternal deaths occur outside the delivery period, with 47% occurring in the antenatal period and 46% occurring postpartum.
The study, led by researchers from McMaster University, Hamilton Health Sciences, and St. Joseph’s Healthcare Hamilton, examined all births after 20 weeks of gestation in Ontario, Canada, from April 1, 2012 to March 31, 2021, using linked administrative and clinical registry data from ICES, an independent, not-for-profit research and analysis organization. The research team extended the study period from pregnancy to six weeks postpartum to cover a wider period of time. Out of approximately 1.1 million live births, the incidence of SMM is 27.24 per 1000 live births, meaning that nearly 10,000 Canadians experience this severe maternal complication each year.
Severe maternal complications are not just a problem in the delivery room. It occurs during pregnancy and after childbirth, and often first occurs in the emergency department rather than the maternity ward. Improving maternal safety requires a whole-systems approach, including emergency medicine, primary care, the obstetric care team, and postpartum follow-up. ”
Dr. Julia Muraka, Senior Author, Perinatal Epidemiologist, Associate Professor, Faculty of Obstetrics, Gynecology, and Health Research Law, McMaster University, Hamilton, Ontario
Research results:
- Severe bleeding, severe preeclampsia, and sepsis were the most common types of SMM. Acute appendicitis and sepsis were the most common SMM events during the antenatal and postnatal periods, respectively.
- 16% of SMM events occurred during the antenatal period, 55% during labor and delivery, and 29% during the 6 weeks postpartum.
- Of all those who experienced an SMM event, 19% visited the emergency department, mostly during the antenatal and postnatal period.
- Risk factors for SMM vary depending on when the event occurs. For example, intrapartum and postpartum complication rates were highest among the youngest and oldest parents, while antepartum pregnancy complications were particularly common among parents aged 15 to 24 years.
- Common factors associated with SMM in all time periods include first pregnancy, maternal race, pre-existing medical conditions, multiple pregnancy, immigration status, low income, rural/remote residence, drug use during pregnancy, and assault.
- Type 1 diabetes had the strongest association with prenatal SMM.
“Our findings, when combined with the knowledge that most maternal deaths do not occur during childbirth, highlight that focusing solely on the duration of labor is not sufficient to recognize, prevent, or respond to SMM (and maternal mortality),” the authors write. “As a result, outpatient surveillance to identify and prevent maternal sepsis, such as postpartum home monitoring (heart rate, blood pressure, etc.) for high-risk individuals, is warranted.”
The authors emphasize that SMM is an important medical and public health problem that requires support, and that extending surveillance during pregnancy could capture more preventable severe maternal diseases.
“These findings highlight the importance of accessible and timely postnatal care, especially among populations at high risk of SMM. In Ontario, suboptimal access to primary care and reduced access to outpatient obstetric care during the postpartum period leave many people without adequate care after giving birth.”
sauce:
Canadian Medical Association Journal
Reference magazines:
Rajasingham, M. others. (2026). Severe maternal morbidity from pregnancy to 6 weeks postpartum in Ontario: a population-based longitudinal cohort study. Journal of the Canadian Medical Association. DOI: 10.1503/cmaj.251425. https://www.cmaj.ca/content/198/10/E344
