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Friday
May272011

Complicating Conditions Listed for 94.1 Percent of 4.2 Million U.S. Births in 2008

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By Jill Arnold

 

AHRQ’s Healthcare Cost and Utilization Project (HCUP) conducted a Nationwide Inpatient Sample (NIS) on pregnancy and childbirth hospitalizations with complicating conditions in 2008. “Complicating conditions” in the document include all ICD-9-CM diagnosis codes under “Complications of Pregnancy, Childbirth, and the Puerperium.”


From the brief:

There were 4,673,700 pregnancy and delivery hospital stays recorded in these hospital discharge data among females ages 15 to 44 years in 2008. As shown in table 1, there were 473,700 non-delivery maternal hospital stays with complicating conditions as a principal or secondary diagnosis. Among the 4.2 million deliveries in 2008, the vast majority (94.1 percent) listed some type of complicating condition. [Emphasis mine]

 

Summary of complicating conditions:

Non-delivery stays
As shown in table 2, among non-delivery maternal stays, the following complicating conditions occurred at a rate of 100 or more for every 1,000 hospital stays: 

  • early or threatened labor (208 per 1,000 stays)
  • infections of genitourinary tract (132 per 1,000 stays)
  • hypertension including eclampsia and pre-eclampsia (113 per 1,000 stays)


The following complicating conditions occurred at a rate of 50-99 for every 1,000 hospital stays: 

  • anemia (99 per 1,000 stays)
  • diabetes or abnormal glucose tolerance (82 per 1,000 stays)
  • hyperemesis gravidarum (vomiting) (63 per 1,000 stays)
  • poor fetal growth (60 per 1,000 stays)
  • ectopic pregnancy (56 per 1,000 stays)
  • advanced maternal age (56 per 1,000 stays)
  • hemorrhage (52 per 1,000 stays)


Delivery stays
Among maternal stays with delivery, the following common complicating conditions occurred at a rate of 100 or more for every 1,000 deliveries: 

  • umbilical cord complications (233 per 1,000 stays)
  • perineal lacerations (158 1st degree and 168 2nd degree lacerations per 1,000 stays)
  • previous cesarean section (167 per 1,000 stays)
  • abnormality in fetal heart rate or rhythm (148 per 1,000 stays)
  • prolonged pregnancy (121 per 1,000 stays)
  • polyhydramnios and problems of the amniotic cavity (117 per 1,000 stays)
  • advanced maternal age (117 per 1,000 stays)
  • anemia during pregnancy (112 per 1,000 stays)
  • fetal distress and abnormal forces of labor (111 per 1,000 stays)


The following complicating conditions occurred at a rate of 50-99 for every 1,000 deliveries: 

  • hypertension including eclampsia and pre-eclampsia (94 per 1,000 stays)
  • early or threatened labor (81 per 1,000 stays)
  • malposition, malpresentation (80 per 1,000 stays)
  • diabetes or abnormal glucose tolerance (68 per 1,000 stays)
  • poor fetal growth (54 per 1,000 stays)
  • fetopelvic disproportion (54 per 1,000 stays)

 

 

 Read the brief: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb113.jsp

 

 

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Reader Comments (19)

I guess there is a small amount of woman 'perfect' for childbearing ;)

May 27, 2011 | Unregistered CommenterNaomi

So they list a previous c-section as a complication-- sorry, "complicating condition" in nearly 17% of stays with delivery. Yet for some reason they barely hesitate to do something that will be a complicating factor for the mother in the future? And 94.1%?!? I must be REALLY lucky with my home births then, as well as the dozen or so other homebirthers I know.

May 27, 2011 | Unregistered CommenterC.Pratt

So much for the notion that complications in pregnancy are rare and that childbirth should be "trusted." Complications are remarkably common.

The difference between now and 100 years ago is not the number of complications, or the rate of complications (with the exception of those related to previous C-section and the use of fetal monitoring), but the survival rate from the complications.

Pregnancy appears safe to many lay people because most complications can be treated with the typical interventions of modern obstetrics. Without those interventions, a substantial proportion of women with complications died. The American maternal mortality rate 100 years ago was approximately 100X higher (99,000%) than it is today.

May 27, 2011 | Unregistered CommenterAmy Tuteur, MD

Well, if you relable all normal variations of pregnancy as 'complications' of course all pregnancies are going to have 'complications'. This is no different that saying '91% of people are deformed', true if you define 'normal' as 5'8", 160lbs, red hair +/- 1 inch of the shoulders, male, between the ages of 25 and 26. Looking at their list of 'complications' a pregnancy apears 'normal' if: a single baby is born to a woman between 18 and 35 who has no prior or current medical history, gained no more than 15 lbs and weighs no more than 150lbs total, the labor began spontaneously at 37 to 39 weeks 6 days, progressed from start to finish in less than 10 hours with baby born over an intact perinium with a long loose cord and 10/10 apgar scores and weighs between 6 and 8 lbs, the placenta detaches spontaneously immediately after the birth and mom has no bleeding. Oh, and baby has to sing the Star Spangled Banner within 30 min of birth! Okay, so I'm being a bit vacisious, but not by much!

May 27, 2011 | Unregistered CommenterJespren

If perineal lacerations are a complication, then the rate of complications used to be close to or at 100%, since episiotomies used to be used nearly 100% of the time.

Also, "advanced maternal age" is a complication? Weird.

And as C. Pratt commented, a previous C-section is a complication, but an iatrogenic one, and probably most "fetal distress and abnormal forces of labor" are too -- "Pit to Distress", anyone?

I wonder what an "umbilical cord complication" is -- everything from a simple nuchal cord that presents no problems to a prolapsed cord or cord rupture that kills (or threatens to kill) the baby?

I also wonder of what value some of these categories of "complications" really are -- so 117/1,000 women were 35+, but does that mean that their pregnancies were in any way different from the <34? Being at higher risk of X does not mean that X will definitely happen, nor that X actually complicated the pregnancy or birth.

May 27, 2011 | Unregistered CommenterKathy

Jill, oh Stats Queen, is there any good source re postpartum complications, by the way? I've always been curious about rates of infection, injury, etc. but have never seen a good set of numbers.

Also I thought hyperemesis gravidarum was *severe* vomiting, not just vomiting--most pregnant and many laboring women vomit, but not always to any detriment.

These confuse me also:

Non-delivery stays
early or threatened labor (208 per 1,000 stays)--early I get, but false alarms are a complication? Or do they mean early labor they manage to stave off? How early?

Delivery stays:
prolonged pregnancy (121 per 1,000 stays)--does this mean simply over 40 weeks?
advanced maternal age (117 per 1,000 stays)--over 35? over 40?

May 27, 2011 | Unregistered Commenteremjaybee

This is taken from coding data, and therefore completely unreliable as any kind of method of data gathering. You can't really even look at it as that most care providers see these as complications.

When it comes to coding, we are taught to code absolutely everything possible. EVERYTHING. Also, notice that things like 1st degree lacerations (even if they are not repaired) are listed as a complication.

I don't believe in Advanced Maternal Age as a diagnosis. It is entirely overinflated. But do I code it? Yes. If it means that our coder can wave her magic wand and get more income for our community clinic, then it means more women I can serve.

What this really is is a reflection of how messed up our billing and coding system is in the US. People are fighting for every possible penny, and having to do so in some weird and wacky ways.

May 28, 2011 | Unregistered CommenterCarrie, CNM

What they fail to recognize is that most of these can be handled easily (and often better) at home by the mother or midwife. With my second child: Malposition, prolonged pregnancy (I'm assuming they mean past 40 weeks? she was 41), risk of early labor, previous c-section, water broke and labor went past 24 hours, labor "stalled" for half a day, labored 42 hours. Born perfectly fine at home! With my third child: Premature (35 weeks), labor "stalled" (never really got consistent at all), previous c-section, labored 71 hours. Born perfectly fine at home! If I was in the hospital, both would have been dangerous repeat c-sections justified by some "complication" that was easily managed at home.

May 28, 2011 | Unregistered CommenterEmily

I agree that to call many of these "complications" is....weird. If that's how we're defining complications, then sure, yeah, lots of births have complications. I wonder what the exact definitions of these are, if any.

Plus, as someone mentioned above, coding is, in my experience, iffy at best. I know that I've had u/s coded as some variant of complication, just to get TRICARE to pay for it. I also know that my IUD was coded as something that meant a correction of my menstrual cycle - because I was in a Catholic system and "oh god please no more babies right now" wouldn't fly.

May 28, 2011 | Registered CommenterANaturalAdvocate

Here's the things I would question as a complication:
Definition of an early or threatened labor(we would send many, many women home thinking they were in labor, but weren't-are these included in these numbers?
Diabetes-how many of these were diet controlled and not needing medical intervention?
Advanced maternal age?-not sure why this is considered a complication unless something else was wrong.
hemorrhage-many hemorrhages can be handled with non medical means-were these hemorrhages that just needed some fundal pressure to stop, or what else was done to stop the bleeding?
Umbilical cord complications-not sure what the definition is for this, but most umbilical cord "problems" can be dealt with efficiently and effectively without a lot of fuss or problem. I've seen a lot of funky umbilical cord stuff that was really not a big deal.
Perineal lacerations-I wouldn't call a 1st that doesn't need a repair much of a complication. My kids get those kind of laceration just by playing baseball.
abnormality is fhr-what is their definition of this? If they have a deceleration, is that an abnormality? How low and how long are the abnormalities persisting/ There is so much disagreement on what is ok and not ok is this area, that I would only call those that need intervention and abnormality and even then many can just be corrected by a change in position. I'm not sure I would categorize it an abnormality unless there were a persistent number of late deceleration or decelerations which are getting lower and more prolonged for an extended amount of time.
Prolonged pregnancy is only a complication if there are complications associated with it.
fetal distress-again, no clear definition as to what this means.
malposition-again, this is only a complication if their are complications associated with it.


Anyways, I think most of these are poorly defined and many are present in a normal labor with no complications, or easily dealt with without medical intervention.

May 28, 2011 | Unregistered CommenterRachel
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