{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T16:21:23Z","timestamp":1790439683409,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2010,12,31]],"date-time":"2010-12-31T00:00:00Z","timestamp":1293753600000},"content-version":"vor","delay-in-days":943,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2008,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective<\/jats:italic>\n                    . To define the rate of severe maternal morbidity in different modes of delivery and to find out if the rate of severe morbidity has changed over a 5\u2010year time span.\n                    <jats:italic>Design<\/jats:italic>\n                    . Retrospective register\u2010based study.\n                    <jats:italic>Setting<\/jats:italic>\n                    . Finnish Medical Birth Registry and Hospital Discharge Registry.\n                    <jats:italic>Population<\/jats:italic>\n                    . All singleton deliveries in Finland in 1997 and 2002 (\n                    <jats:italic>n<\/jats:italic>\n                    = 110,717).\n                    <jats:italic>Methods<\/jats:italic>\n                    . Diagnoses and operative interventions recorded in the Hospital Discharge Registry indicating a severe maternal complication were linked with Birth Register data and compared by mode of delivery: spontaneous vaginal delivery (VD), instrumental VD, elective cesarean section and non\u2010elective cesarean section. Main outcome measures were severe maternal morbidity: deep venous thromboembolism and amniotic fluid embolism, major puerperal infection, severe hemorrhage, events requiring operative intervention after delivery, uterine rupture and inversion, and intestinal obstruction.\n                    <jats:italic>Results<\/jats:italic>\n                    . Severe maternal morbidity was more frequent in cesarean than vaginal deliveries (\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.001), and more frequent in non\u2010elective than in elective operations (\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.001). The rate of severe maternal morbidity increased considerably from 1997 to 2002; from 5.9 to 7.6 per 1,000 in all deliveries (\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.001), from 4.0 per 1,000 to 5.2 per 1,000 in spontaneous vaginal deliveries (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.005), from 9.9 per 1,000 to 12.1 per 1,000 in elective cesarean sections (CSs) (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.164), and from 19.6 per 1,000 to 27.2 per 1,000 in non\u2010elective CSs (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.090), respectively.\n                    <jats:italic>Conclusions<\/jats:italic>\n                    . Severe maternal morbidity has increased both in cesarean and vaginal deliveries from 1997 to 2002. Cesarean delivery, even an elective one, carries a significantly higher risk of life\u2010threatening maternal complications than VD.\n                  <\/jats:p>","DOI":"10.1080\/00016340802108763","type":"journal-article","created":{"date-parts":[[2008,5,12]],"date-time":"2008-05-12T13:04:51Z","timestamp":1210597491000},"page":"662-668","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":100,"title":["Severe maternal morbidity and the mode of delivery"],"prefix":"10.1111","volume":"87","author":[{"given":"NANNELI","family":"PALLASMAA","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ULLA","family":"EKBLAD","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MIKA","family":"GISSLER","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,12,31]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016340701644876"},{"issue":"8452","key":"e_1_2_6_3_2","first-page":"436","article-title":"Appropriate technology for birth","volume":"2","author":"World Health Organisation","year":"1985","journal-title":"Lancet"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016349409013384"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/01443610050009485"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.01.010"},{"issue":"3","key":"e_1_2_6_7_2","first-page":"175","article-title":"Infant and neonatal mortality for primary cesarean and vaginal births to women with \u201cno indicated risk\u201d, United States, \u20132001 birth cohorts","volume":"2006","author":"MacDorman M","year":"1998","journal-title":"Birth.; 33"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767050500333868"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39363.706956.55"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1089"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1990.tb02442.x"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1077558703260123"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060870"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-004-0692-0"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00933.x"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00624.x"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2006.20"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00004.x"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016340701207500"},{"key":"e_1_2_6_20_2","unstructured":"Smaill F Hofmeyr GJ.Antibiotic prophylaxis for cesarean section.Cochrane Database Syst Rev.2000:(2):CD(000933)."},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1159\/000087208"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000219750.79480.84"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.074"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/140349489502300113"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1080%2F00016340802108763","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1080\/00016340802108763","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T03:20:56Z","timestamp":1696994456000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1080\/00016340802108763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,6]]},"references-count":23,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2008,6]]}},"alternative-id":["10.1080\/00016340802108763"],"URL":"https:\/\/doi.org\/10.1080\/00016340802108763","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,6]]},"assertion":[{"value":"2010-12-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}