Measuring severe maternal morbidity: validation of potential measures

Main, Elliott K.; Abreo, Anisha; McNulty, Jennifer; Gilbert, William M.; McNally, Colleen; Poeltler, Debra; Lanner-Cusin, Katarina; Fenton, Douglas; Gipps, Theresa; Melsop, Kathryn; Greene, Naomi; Gould, Jeffrey B.; Kilpatrick, Sarah J.

doi:10.1016/j.ajog.2015.11.004

Cited by 212 publications

(207 citation statements)

References 8 publications

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“…We identified true SMM cases based on the Gold Standard Severe Maternal Morbidity Case Review Guidelines as previously described (7). Briefly, all deliveries were initially screened using four strategies: 1) CDC ICD-9 diagnosis and procedure codes, 2) prolonged postpartum length of stay (>4 days for a vaginal delivery or 6 days for a cesarean delivery), 3) any maternal ICU admission, and 4) blood transfusion.…”

Section: Methodsmentioning

confidence: 99%

“…The charts of women who screened positive were subsequently reviewed in detail to determine if true SMM was present based on the Gold Standard Guidelines (S.J.K, N.G.) given that the positive predictive value based on CDC ICD-9 codes is only 0.44 (7). …”

Section: Methodsmentioning

confidence: 99%

“…The Gold Standard Guidelines were developed by a team of 10 obstetric researchers experienced in quality reviews (7). The team first developed a set of consensus clinical conditions establishing a “gold standard” to identify true SMM.…”

Section: Methodsmentioning

confidence: 99%

“…True examples of SMM include, but are not limited to, eclampsia, respiratory failure, and peripartum hysterectomy. Various criteria have been proposed to define SMM cases, including 1) maternal intensive care unit (ICU) admission or transfusion of ≥4 units of blood products (4, 5), 2) utilization of CDC ICD-9 codes associated with maternal morbidity and mortality (1, 6), and 3) most recently, a clinical gold standard used to validate relevant CDC ICD-9 codes (7). Three of the known risk factors for SMM, older age, multiple birth, and cesarean delivery (8), are associated with fertility treatment, which has also been on the rise over the last few decades.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there are two recent studies that examined whether these associations translate into increased SMM, which concluded that singleton pregnancies conceived with assisted reproductive technology (ART) had a twofold increased risk of SMM (17, 18). However, both of these studies utilized only CDC ICD-9 codes to identify SMM cases, which have a low positive predictive value of 0.44 when validated with medical record review (7). …”

Section: Introductionmentioning

confidence: 99%

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Impact of fertility treatment on severe maternal morbidity

Wang

Ozimek

Greene

et al. 2016

Fertility and Sterility

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Objective To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared to spontaneous pregnancies. Design Retrospective cohort study Setting Single academic medical center Patients In 2012, 6543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies. Interventions None Outcome Measure The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened using 1) ICD-9 codes, 2) prolonged postpartum stay, 3) maternal ICU admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the gold standard. Results Of the 6543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty nine (1.1%) cases of true SMM were identified. In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared to spontaneous conceptions (OR 2.40, 95%CI 1.10–5.23). In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant (OR 2.11, 95% CI 0.83–5.37, P=0.12). Conclusions Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multi-center studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of fertility treatment on severe maternal morbidity

Wang

Ozimek

Greene

et al. 2016

Fertility and Sterility

Self Cite

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show abstract

Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

et al. 2021

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Key Points Question What proportion of de novo severe maternal morbidity is diagnosed after delivery discharge, and what are the most common factors and maternal characteristics associated with severe maternal morbidity among women in the US? Findings In this cohort study of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014, 14% and 16% of severe maternal morbidity among those with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after delivery discharge. The most common factors and maternal characteristics associated with severe maternal morbidity after delivery were different than those identified at delivery. Meaning The study’s findings suggest that expanding the focus of severe maternal morbidity assessment to the postdelivery discharge period could improve understanding of severe maternal morbidity and may create opportunities to improve maternity care.

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Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity

et al. 2022

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IMPORTANCEAddressing severe maternal morbidity (SMM) is a public health priority in the US. Use of labor neuraxial analgesia for vaginal delivery is suggested to reduce the risk of postpartum hemorrhage (PPH), the leading cause of preventable severe maternal morbidity. OBJECTIVE To assess the association between the use of labor neuraxial analgesia for vaginal delivery and SMM. DESIGN, SETTING, AND PARTICIPANTS In this population-based cross-sectional study, women

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Measuring severe maternal morbidity: validation of potential measures

Cited by 212 publications

References 8 publications

Impact of fertility treatment on severe maternal morbidity

Impact of fertility treatment on severe maternal morbidity

Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity

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