Trends in intrapartum morbidity: United States, 1993-2005

Healthy People 2010 calls for a reduction in the percent of maternal complications in intrapartum hospitalizations from 31.2% in 1998 to 24% by 2010. This goal was based on an earlier analysis by Danel and Berg, using 1993-1997 data from the National Hospital Discharge Survey. The authors report on progress toward this goal.

Using data from the 2001-2005 National Hospital Discharge Survey and previously identified ICD-9CM codes for intrapartum morbidity, estimates and standard errors were calculated for the percent of women who had a maternal complication at delivery (obstetric complication or preexisting medical condition) and/or cesarean delivery. Trends were analyzed by year, and rates for 2001-2005 were compared with published rates for 1993-1997. A two-sided z-test was used to evaluate statistical significance.

In 2001-2005, the intrapartum morbidity rate was 31.6% essentially unchanged from 1993-1997 (obstetrical complications = 28.6% and preexisting medical conditions = 4.9%). Several of the most common intrapartum morbidities changed over time, including significant increases in rates of preeclampsia/eclampsia, gestational hypertension, postpartum hemorrhage, and gestational diabetes, and significant decreases in rates of third and fourth degree peritoneal lacerations, other obstetrical trauma, and urinary tract infection. Significant increases were also apparent in rates for asthma, chronic hypertension, and diabetes. Comparing 1993-1997 to 2001-2005, the cesarean rate increased from 22% to 28%. The total morbidity rate (maternal complication and/or cesarean delivery) increased from 43.0% to 48.5% between the two time periods.

It is unlikely that the 2010 objective will be achieved, even with further prevention efforts to decrease maternal morbidity.