Ectopic pregnancy-related severe maternal morbidity in Shenzhen: a sentinel indicator for gaps in early pregnancy care systems

Background: Despite China's progress in reducing maternal mortality, severe maternal morbidity in early pregnancy, particularly ectopic pregnancy, remains a critical challenge in urban settings like Shenzhen. This study examines the clinical presentation scenarios, types, and sociodemographic compositions of ectopic pregnancy -related severe maternal morbidity to map potential structural vulnerabilities within the maternal healthcare continuum and propose interventions aligned with China's 'Healthy Motherhood 2030' agenda. Methods: A retrospective analysis used 2023 data from Shenzhen's Maternal and Child Health Care Management Information System, covering 66 maternity hospitals. A total of 245 ectopic pregnancy-related severe maternal morbidity cases were identified using standard WHO near-miss criteria. Statistical analyses evaluated the descriptive distributions and baseline profiles of clinical outcomes across different initial resuscitation settings. Results: Among 154,000 live births, 1,075 severe maternal morbidity cases (0.70%) included 257 (23.9%) ectopic pregnancy-related emergencies. After exclusions, we analysed 245 cases: 67.35% multiparous women, 31.84% had a junior high education or lower and 95% without prenatal care. Ectopic pregnancy-severe maternal morbidity occurred mostly at home (46.12%), followed by outpatient/emergency (30.20%) and inpatient (23.67%) settings. Among home/emergency presentations, 83.3% of women had lower education and 80.4% were employed. Tubal isthmus pregnancies (42.45%) dominated home-based emergencies, while atypical sites were frequent in clinical settings. Advanced severe complications occurred in only seven cases, limiting meaningful statistical comparisons across settings. Conclusions: In a high-resource, low-MMR urban environment, ectopic pregnancy-related emergencies account for nearly one-quarter of the total SMM burden, with acute crises often concentrated in pre-hospital or frontline care settings. These descriptive patterns suggest that maternal safety strategies should consider shifting focus toward enhancing community health literacy and rapid-response integration at the primary care level. Forward-looking interventions - such as mobile health platforms, clinical simulation training, and formalised early pregnancy emergency networks - warrant prospective evaluation as potential operational pathways to bridge the identified gaps.