Complication during childbirth: How to advise women who are at risk of recurrence

A woman is three times more likely to have severe complications during her second birth if there was serious maternal morbidity with the first, according to new research out of Quebec. The study, conducted by the Research Institute of the McGill University Health Center (IR-MUHC) and recently published in the American Journal of Obstetrics & Gynecology, analyzed a cohort of 1,406,874 pregnant Quebec women between 1989 and 2021 who had given birth at least twice in hospital. The researchers found that almost 3% experienced serious maternal morbidity during their first birth and that their recurrence rate was 65.2 per 1000, compared to 20.3 per 1000 among those who hadn’t. Of those 3%, women were more likely to 35 years of age or older, had pre-existing comorbidities and socioeconomically disadvantaged. Read: B.C. clinic says it can’t keep up with demand for IUDs Equip yourself after a difficult birth The study results allow health specialists to better advise women who have suffered complications during their first childbirth. “It is always possible to have another pregnancy after severe morbidity during childbirth. The absolute risk is roughly less than 1%. It is therefore only in very rare cases that the doctor will not recommend a second pregnancy,” says lead study author Natalie Dayan, a scientist at IR-MUHC. She says patients who've had complications during childbirth often want to know their risk of recurrence. To do this, she recommends doctors assess the intensity of complications experienced during childbirth. “If there is one thing to remember, it is to look at how severe the first birth was in terms of complications. If the patient was in intensive care and needed to be on a ventilator, for example, that greatly increases her risk of recurrence compared to someone who only had a hemorrhage with a blood transfusion.” She also advises doctors assess the type of complication. “Certain complications provide a lot of information about the risk of recurrence. For example, we know that heart problems during the first pregnancy will resurface during the second pregnancy,” she says. “Heart problems also give an indication that there may be an underlying disease that was not known during the pregnancy.” Read: The U.K.’s first successful womb transplant—key questions answered The study highlights that women who suffered cardiac complications during their first delivery were most at risk of experiencing a second delivery with serious maternal morbidities. When it comes to cardiac complications, the risk for having a delivery with morbidities is seven times higher than if the woman did not experience complications. Often, when the first delivery has serious complications, the next delivery is strongly associated with cardiac complications and severe preeclampsia. Dayan suggests that there are solutions to support women during the second pregnancy in order to minimize risks. “If the patient has a specific condition, it is important that she finds herself in a [hospital] centre where there are specialists who can take care of her, such as cardiologists or specialists in neonatology,” she says. “There are specific interventions too, such as baby aspirin to prevent preeclampsia.” This article was translated from French and originally ran in our sister publication Profession Santé.

Complication during childbirth: How to advise women who are at risk of recurrence

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