From: A global view of severe maternal morbidity: moving beyond maternal mortality
Author (Year) | Country | Definition of SMM | Estimated Prevalencea | Leading Causes |
---|---|---|---|---|
Bouvier-Colle (2012) [13] | 17 EU Countries | Eclampsia | 0.2–1.6 | |
3 EU Countries | ICU Admission | 0.5–3.1 | ||
10 EU Countries | Blood Transfusion | 0.1–11.5 | ||
15 EU Countries | Hysterectomy | 0.2–1.0 | ||
7 EU Countries | Embolisation | 0.0–0.3 | ||
Colmorn (2015) [71] | Denmark, Finland, Iceland, Norway, and Sweden | Complete uterine rupture | 5.6 | |
Deneux-Tharaux (2017) [16] | France | Obstetric hemorrhage, hypertensive complications, Psychiatric disorder, decompensation of preexisting condition, pulmonary embolism, sepsis, stroke, amniotic fluid embolism, other | 13.9 | Obstetric hemorrhage (65.2%), hypertensive conditions (21.6%) |
Jayaratnam (2016) [45] | Australia | WHO criteria | 4.8 | Hemorrhage |
Jayaratnam (2011) [72] | Australia | Antepartum hemorrhage requiring emergency surgery, PPH requiring surgery, any postnatal patient requiring surgery, severe pre-eclampsia/eclampsia/HELLP, ICU admission, shock, acute ruptured ectopic, pulmonary embolism, other conditions requiring immediate medical assessment | 6.0 | |
Kilpatrick (2016) [43] | United States | CDC method with chart review to confirm condition was truly life-threatening | 7.3 | Hemorrhage, hypertensive disorders |
Lawton (2016) [personal communication] | New Zealand | ICU/HDU admission | 6.2 | Major blood loss, pre-eclampsia, sepsis |
Lyndon (2012) [73] | United States | CDC method supplemented with birth certificate data | 5.8 | |
Main (2016) [74] | United States | “Gold standard” clinical guidelines | 7.3 | |
Marr (2014) [40] | Scotland | Major obstetric hemorrhage, eclampsia, renal or liver dysfunction, pulmonary edema, acute respiratory distress, coma, cerebrovascular event, status epilepticus, anaphylactic shock, septicemic shock, anesthetic problem, massive pulmonary embolism, ICU/coronary care unit admission | 6.1 | Major obstetric hemorrhage, ICU/coronary care admission |
Nair (2016) [20] | England | Acute abdomen | 0.01 | |
Acute renal failure | 0.08 | |||
Acute psychosis | 0.05 | |||
Cardiac arrest/failure or infarction | 0.05 | |||
Cerebral edema or coma | 0.01 | |||
DIC | 0.01 | |||
Cerebrovascular accident | 0.04 | |||
Major complications of anesthesia | 0.06 | |||
Obstetric embolism (inc. AFE) | 0.27 | |||
Shock | 0.20 | |||
Sickle cell crisis | 0.05 | |||
Status asthmaticus | 0.02 | |||
Status epilepticus | 0.03 | |||
Uterine rupture | 0.48 | |||
Eclampsia | 0.71 | |||
Sepsis | 0.44 | |||
Cerebral venous thrombosis | 0.003 | |||
Assisted ventilation including tracheostomy | 0.15 | |||
Curettage with general anesthesia | 0.01 | |||
Dialysis | 0.01 | |||
Evacuation of hematoma | 0.50 | |||
Hysterectomy | 0.24 | |||
Procedures to reduce blood flow to uterus | 0.06 | |||
Re-closure of disrupted cesarean section wound | 0.31 | |||
Repair of bladder or cystostomy | 0.31 | |||
Repair of intestine | 0.008 | |||
O’Malley (2016) [75] | Ireland | WHO criteria | 3.6 | Hemorrhage |
Scottish Audit of SMM criteria | 18.4 | Hypertension | ||
Ozimek (2016) [37] | United States | “Gold standard” clinical guidelines from Main (2016) | 9.2 | Hemorrhage, preeclampsia/eclampsia |
Zanconato (2012) [44] | Italy | ICU admission, transfusion ≥4 units, emergency peripartum hysterectomy, arterial embolization | 8.5 | Hypertensive disorders, hemorrhage, sepsis |
Zwart (2010) [76] | The Netherlands | ICU admission, eclampsia/HELLP syndrome, uterine rupture, major hemorrhage, miscellaneous | 7.1 overall 6.3 Western ethn 8.4 non-Western ethn | |
Peripartum hysterectomy | 3.5 | |||
Abnormally invasive placenta | 4.6 | |||
Severe hemorrhage at delivery | 11.6 |