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A register-based observational cross-sectional study was conducted using public hospital admission delivery episodes. SMM was identified using the Centers for Disease Control and Prevention (CDC) indicators. Descriptive statistics, Mann\u2013Kendall trend test, binary logistic regression and adjusted logistic regression were used to assess trends and associated factors. Between 2010 and 2018, 8,854 delivery episodes met the criteria for SMM. Blood transfusion, acute renal failure, and shock showed the highest increase in rate per 1,000 hospitalized deliveries. SMM rate was 13.14 per 1,000 deliveries and 3.22 per 1,000 deliveries without blood transfusion. Maternal age (\u2265\u200940 years adjusted odds ratio (OR) 1.38, 95% confidence intervals (CI) 1.09\u20131.66), hospitalized days (adjusted OR 1.04, 95% CI: 1.04\u20131.05), number of diagnoses (adjusted OR 1.27, 95% CI 1.25\u20131.28) and procedures during hospitalization (adjusted OR 1.26, 95% CI 1.24\u20131.27), and International Classification of Diseases, 10th edition,\u00a0Clinical Modification and Procedure Coding System (ICD-10-CM\/PCS) (adjusted OR 1.63, 95% CI: 1.08\u20132.18) were significantly associated with a higher risk of SMM. After 2015, the risk of SMM decreased. SMM with blood transfusion was positively associated with hospitalization days, number of diagnoses, procedures, residing in Algarve, Alentejo or Centro, and ICD-10-CM\/PCS. Trends in SMM between 2010 and 2018 in Portugal show an increase, particularly for blood transfusion. Risk factors included age, hospitalization length, intensity of diagnoses and procedures, and ICD-10-CM\/PCS coding.<\/jats:p>","DOI":"10.1038\/s41598-026-42363-9","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T08:43:56Z","timestamp":1775292236000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends and factors associated with delivery hospitalizations involving severe maternal morbidity in portuguese public hospitals: A population-based study (2010\u20132018)"],"prefix":"10.1038","volume":"16","author":[{"given":"Catarina","family":"Camarinha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Miguel","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"de Ara\u00fajo Nobre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Furtado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cec\u00edlia","family":"Elias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonor","family":"Bacelar-Nicolau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreia Silva","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Jorge","family":"Nogueira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,4]]},"reference":[{"key":"42363_CR1","unstructured":"World Health Organization. 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The data were anonymized by ACSS prior to access, ensuring compliance with national and European data protection regulations, including The General Data Protection Regulation.\u00a0The study adheres to ethical principles for medical research, maintaining strict confidentiality and data security. No direct contact or primary collection of individual data occurred and no linkage with other personal data sources was performed. All analyses were conducted on de-identified data, reported in aggregate form, with no possibility of re-identification. The data used were strictly limited to the research objectives of this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics"}}],"article-number":"16232"}}