{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:44:10Z","timestamp":1783464250184,"version":"3.55.0"},"reference-count":57,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82260646"],"award-info":[{"award-number":["82260646"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["MS2025\u2010536"],"award-info":[{"award-number":["MS2025\u2010536"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Numerous risk assessment tools for severe maternal outcomes (SMOs) exist, but systematic evaluations of prediction models for non\u2010ICU settings are lacking, where the majority of antenatal and intrapartum care is provided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review and critically appraise prognostic models for predicting SMOs in non\u2010ICU settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Strategy<\/jats:title>\n                    <jats:p>PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched from June 1, 2009, to November 22, 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>Studies developing, validating or updating multivariable prognostic models for SMOs in non\u2010ICU settings were included. Eligible populations were pregnant women and those within 42\u2009days postpartum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>Two reviewers independently conducted screening, data extraction and quality assessment using CHARMS and PROBAST AI. A narrative synthesis was performed due to study heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>Thirteen studies reporting 15 evaluations of 13 distinct prognostic models were included. Study populations encompassed pregnant or postpartum women in non\u2010ICU settings, including general obstetric admissions and specific high\u2010risk cohorts (acute fatty liver of pregnancy, liver dysfunction, pulmonary hypertension and cardiac arrest). Models demonstrated moderate to good discrimination (C\u2010statistics 0.74\u20130.95), yet all 15 evaluations were assessed as high risk of bias due to inadequate sample sizes, inappropriate variable selection, poor missing data management, arbitrary categorisation of continuous predictors, temporal misalignments between predictor measurement and intended use, and insufficient internal validation. Only five models underwent external validation, and none reported calibration performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings underscore the need for enhanced methodological rigour, models tailored to specific gestational stages, comprehensive outcome definitions and dynamic risk assessment, thereby facilitating their feasible integration into clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70124","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T09:43:21Z","timestamp":1767606201000},"page":"985-995","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prediction Models for Severe Maternal Outcomes in Non\u2010\n                    <scp>ICU<\/scp>\n                    Settings: Systematic Review"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-2463","authenticated-orcid":false,"given":"Zhongchen","family":"Luo","sequence":"first","affiliation":[{"name":"School of Nursing Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"},{"name":"School of Nursing Guizhou Medical University  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangyan","family":"Li","sequence":"additional","affiliation":[{"name":"School of Nursing Guizhou Medical University  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofang","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Nursing Guizhou Medical University  Guiyang China"},{"name":"Department of Obstetrics and Gynecology The Affiliated Hospital of Guizhou Medical University  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianhuan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Affiliated Hospital of Guizhou Medical University  Guiyang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Tang","sequence":"additional","affiliation":[{"name":"School of Nursing Chongqing Medical University  Chongqing China"},{"name":"Department of Nursing The First Affiliated Hospital of Chongqing Medical  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing Lanzhou University  Lanzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotong","family":"Ding","sequence":"additional","affiliation":[{"name":"School of Nursing Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"},{"name":"School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongli","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Nursing Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Li","sequence":"additional","affiliation":[{"name":"School of Nursing Chinese Academy of Medical Sciences &amp; Peking Union Medical College  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Evaluating the Quality of Care for Severe Pregnancy Complications: The WHO Near\u2010Miss Approach for Maternal Health","author":"World Health Organization","year":"2011"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2009.01.007"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.15698"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010017\u20101581\u20104"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1456841"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.2147\/ijwh.S341912"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13739"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/2594343"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed\u20102022\u2010213057"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/grf.0000000000000473"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2022.2134391"},{"key":"e_1_2_12_13_1","volume-title":"Acutely Ill Adults in Hospital: Recognising and Responding to Deterioration (CG50)","author":"National Institute for Health and Care Excellence (NICE)","year":"2007"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.05.046"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013795.pub2"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2015.1064497"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.srhc.2018.04.008"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010021\u201004132\u20106"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41512\u2010019\u20100060\u2010y"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010144\u20103\u2010200602070\u201000009"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102022\u2010073538"},{"key":"e_1_2_12_23_1","unstructured":"World Health Organization \u201cMaternal Mortality Ratio (per 100 000 Livebirths) \u201daccessed May 1 2025 https:\/\/www.who.int\/data\/gho\/indicator\u2010metadata\u2010registry\/imr\u2010details\/3140."},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.2471\/blt.09.071001"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001856"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102024\u2010082505"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102023\u2010078378"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010020\u201003215\u20100"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010024\u201007539\u20106"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0064157"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31828b33a4"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/4419722"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.719906"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2021.04.027"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13224\u2010023\u201001859\u20104"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.814557"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102020\u2010038910"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010023\u201005503\u2010x"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12664\u2010016\u20100704\u20106"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010013\u20101391\u2010x"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m441"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102014\u2010006676"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2004.11.026"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208563"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102981"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2025.111833"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(14)70227\u2010x"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970\u20100218.137145"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12219"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20101877\u20108918"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw302"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.16379"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.17983"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.12126"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.04.005"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0000000000005758"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(21)00079\u20106"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.70124","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.70124","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.70124","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:47:41Z","timestamp":1775710061000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.70124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":57,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/1471-0528.70124"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.70124","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"assertion":[{"value":"2025-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}