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Table 1 Estimates of the Prevalence of Severe Maternal Morbidity in High-Income Countries

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

 
  1. aPer 1000 live births