Severe Acute Maternal Morbidity in a High-Income Developing Multiethnic Country

With declining maternal mortality, the study of severe acute maternal morbidity (SAMM) provides an opportunity to measure the quality of maternal care and to identify ways to improve it. The objective was to study the epidemiology of severe acute maternal morbidity in a high income, rapidly developing, multiethnic country in the Middle East, and to determine the role of ethnicity in maternal morbidity. We included all births occurring in maternal units with more than 500 births a year over a 6 year period in Abu Dhabi emirate, the largest province of the United Arab Emirates. Data on SAMM was collected retrospectively for the first 3 years and prospectively for the later 3 years. A clinical criteria based approach was used to define SAMM. Over the 6 year period there were 122,705 deliveries, and a total of 926 cases of SAMM were identified. The SAMM to births ratio was 7.5/1,000 deliveries. The leading cause of maternal morbidity was hypertensive disorders (59.5 %) followed by hemorrhage (39.6 %). There were clear ethnic differences. Preeclampsia was significantly higher in women from the Indian sub-continent and hemorrhage was more prevalent in UAE women. We have shown that it is possible to use a clinical criteria based approach to study the epidemiology of SAMM. The leading contributors to SAMM were hypertensive disorders and hemorrhage with clear ethnic links supporting earlier reports of a complex interaction between ethnicity, socioeconomic status and maternal health.