Development and validation of a questionnaire to identify severe maternal morbidity in epidemiological surveys

OBJECTIVE to develop and validate a questionnaire on severe maternal morbidity and to evaluate the maternal recall of complications related to pregnancy and childbirth. DESIGN validity of a questionnaire as diagnostic instrument. SETTING a third level referral maternity in Campinas, Brazil. POPULATION 386 survivors of severe maternal complications and 123 women that delivered without major complications between 2002 and 2007. METHODS eligible women were traced and interviewed by telephone on the occurrence of obstetric complications and events related to their treatment. Their answers were compared with their medical records as gold standard. Sensitivity, specificity and likelihood ratios plus their correspondent 95% confidence intervals were used as main estimators of accuracy. MAIN OUTCOMES diagnosis of severe maternal morbidity associated with past pregnancies, including hemorrhage, eclampsia, infections, jaundice and related procedures (hysterectomy, admission to ICU, blood transfusion, laparotomy, inter-hospital transfer, mechanical ventilation and post partum stay above seven days). RESULTS Women did not recall accurately the occurrence of obstetric complications, especially hemorrhage and infection. The likelihood ratios were < 5 for hemorrhage and infection, while for eclampsia it almost reached 10. The information recalled by women regarding hysterectomy, intensive care unit admission and blood transfusion were found to be highly correlated with finding evidence of the event in the medical records (likelihood ratios ranging from 12.7-240). The higher length of time between delivery and interview was associated with poor recall. CONCLUSION Process indicators are better recalled by women than obstetric complication and should be considered when applying a questionnaire on severe maternal morbidity.