Determining the Rate and Causes of Severe Maternal Morbidity to Improve Obstetric Quality of Care [9R]

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Identifying cases of severe maternal morbidity (SMM) and reviewing the underlying cause is essential to improving quality of obstetrical care. We sought to determine the rate and causes of SMM using an expanded definition including ICU admission, unanticipated hysterectomies, 2 or more liters blood loss (EBL), transfusion of 4 or more units of any blood product, and select readmissions.


We prospectively identified women who met criteria for SMM at our institution from July 1, 2014 to June 30, 2015. All cases were reviewed and discussed by a multidisciplinary team. Analysis was limited to patients who delivered at our institution.


4198 deliveries occurred during the 12 month period. Fifty-two (1.2%) women experienced a SMM (62% cesarean deliveries, 89% postpartum). Of the 52 women, 29 (56%) met 1 criteria, 20 (38%) met 2 criteria, and 3 (6%) met 3 or more criteria (33% ICU, 46% blood products, 62% EBL, 6% hysterectomies, 12% readmissions). Women with cesarean delivery were more likely to experience more than 4 units pRBCs as reason for SMM (P=.05). ICU admissions were no different by mode of delivery. Restricting the definition of SMM to ICU admission and 4 or more units of pRBC identified only 69%.


SMM occurs more postpartum and in women with cesarean deliveries. Restricting the SMM definition leads to missed opportunities in identifying additional cases of SMM, specifically those with large EBL and readmissions with delayed morbidity. Future tracking and evaluation of SMM should include large EBL and postpartum readmission to help identify and improve all aspects of SMM.

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