Serious maternal complications affected nearly 30 in every 1,000 pregnancies in Ontario from conception to six weeks after birth, according to new research that highlights what experts say is a need to extend the period that patients are monitored.

The study, published Monday in the Canadian Medical Association Journal, reinforces calls from maternal health experts to establish a national framework for standardized collection and surveillance of maternal mortality and morbidity data.

Researchers from McMaster University, Hamilton Health Sciences, and St. Joseph’s Healthcare Hamilton looked at almost 1.1 million births in Ontario between April, 2012, and March, 2021, using administrative and clinical registry data. They examined not only the traditional monitoring period of labour and delivery, but extended surveillance from conception to six weeks postpartum.

They found that the rate of severe maternal morbidity (SMM), which can include severe hemorrhaging, severe pre-eclampsia, acute appendicitis and sepsis, was 27.24 per 1,000 births.

This translates to nearly 10,000 patients who experience these severe maternal complications every year, the authors noted.

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Giulia Muraca, one of its authors and a perinatal epidemiologist and associate professor at McMaster University, said consequences of complications can extend far beyond the delivery room.

“Survivors can face long-term physical health problems, mental health problems, increased risk in future pregnancy,” she said in an interview. “It’s a really important indicator to keep track of.”

The study’s findings correspond with coroner’s data in Ontario that shows most maternal deaths occur outside labour and delivery, with 47 per cent occurring in the prenatal period and 46 per cent postpartum.

Prof. Muraca said previous national estimates that looked only at cases that took place during labour and delivery found about 1.7 per cent of patients had severe complications.

However, their research team found a much higher rate when examining the frequency of these events from the outset of a pregnancy until six weeks after birth.

They found by extending the monitoring period for severe pregnancy complications, 40 per cent of cases were previously missed.

“Our higher rate is consistent with studies that have implemented similar, expanded definitions of SMM, which range from 23.0 to 30.9 per 1000 births,” the authors wrote.

“Our findings, combined with the knowledge that most maternal deaths do not occur during delivery, highlight that focusing only on the intrapartum period will not adequately serve to recognize, prevent, or respond to SMM (and maternal deaths),” the authors wrote.

“As a result, outpatient surveillance to identify and prevent maternal sepsis is warranted, such as postpartum home monitoring (e.g., heart rate, blood pressure) for individuals at increased risk.”

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Sepsis can be life-threatening. The condition causes the body to go into overdrive in response to an infection, and left untreated it can destroy organs. Physicians say the key is to watch for signs, including a fever, pain and a racing heart and ensure patients receive medical intervention quickly.

Last June, Ontario resident Ravinder Kaur Sidhu died after childbirth after she developed postpartum sepsis that led to organ failure. Her husband, Gurinder Sidhu, is pushing for reforms to sepsis protocols in hospitals to ensure early detection and treatment.

Mr. Sidhu said his wife would likely still be alive today had she not had to wait more than 30 hours to receive antibiotics at a hospital.

Last year, he told The Globe and Mail that he remains haunted by watching his wife’s health decline in hospital while he urged medical staff to act.

McMaster’s Prof. Muraca said there is a need to further research on obstetric sepsis.

“One of the things that we’re doing in our future work is taking a really deep dive at looking at sepsis cases in postpartum people,” she said.

The research will involve looking at patients who are at greater risk to better understand the root cause of infections that escalated to sepsis, Prof. Muraca added.