{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T21:26:55Z","timestamp":1773178015439,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T00:00:00Z","timestamp":1477008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K08\u2010HD082287"],"award-info":[{"award-number":["K08\u2010HD082287"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We examined rates of serious maternal complications in relation to severe pre\u2010eclampsia based on the delivering hospital's annualised volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population and setting<\/jats:title><jats:p>Singleton deliveries (<jats:italic>n<\/jats:italic> = 25 782 235) in 439 hospitals in the <jats:styled-content style=\"fixed-case\">USA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Annualised hospital volume was categorised as 25\u2013500, 501\u20131000, 1001\u20132000 and &gt;2000.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Rates of in\u2010hospital maternal death and serious maternal complications, including puerperal cerebrovascular disorders, pulmonary oedema, disseminated intravascular coagulation, acute renal, heart and liver failure, sepsis, haemorrhage and intubation in relation to severe pre\u2010eclampsia. We derived adjusted risk ratio (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) and 95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>), from hierarchical Poisson regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Severe pre\u2010eclampsia was associated with an 8.7\u2010fold (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 7.6, 10.1) risk of composite maternal complications, with similar <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>s across levels of hospital volumes. However, compared with hospitals with low annual volume (&lt;2000), maternal mortality rates in relation to severe pre\u2010eclampsia were lower in high volume hospitals. The rates of serious maternal complications were 410.7 per 10 000 to women who delivered in hospitals with a high rate of severe pre\u2010eclampsia (\u22652.12%) and 584.8 per 10 000 to women who delivered in hospitals with low severe pre\u2010eclampsia rates (\u22640.41; <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.75, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.24, 2.45).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>While the risks of serious maternal complications in relation to severe pre\u2010eclampsia was similar across hospital delivery volume categories, deaths showed lower rates in large delivery volume hospitals than in smaller volume hospitals. The risk of complications was increased in hospitals with low compared with high severe pre\u2010eclampsia rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Hospital volume had little impact on the association between severe pre\u2010eclampsia and maternal complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14384","type":"journal-article","created":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T23:54:43Z","timestamp":1477094083000},"page":"1246-1253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Serious maternal complications in relation to severe pre\u2010eclampsia: a retrospective cohort study of the impact of hospital volume"],"prefix":"10.1111","volume":"124","author":[{"given":"CV","family":"Ananth","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology College of Physicians and Surgeons Columbia University  New York NY USA"},{"name":"Department of Epidemiology Joseph L. 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