{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:01Z","timestamp":1787013841051,"version":"build-2736575974"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T00:00:00Z","timestamp":1657584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000667","name":"Obstetric Anaesthetists' Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000667","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Using a cohort study design, we analysed 17 diagnoses and 9 interventions (including critical care admission) as a composite measure of severe maternal morbidity for pregnancies recorded over 14\u2009years in Scotland. There were 762,918 pregnancies, of which 7947 (10 in 1000 pregnancies) recorded 9345 severe maternal morbidity events, 2802 episodes of puerperal sepsis being the most common (30%). Severe maternal morbidity incidence increased from 9 in 1000 pregnancies in 2012 to 17 in 1000 pregnancies in 2018, due in part to puerperal sepsis recording. The odds ratio (95%CI) for severe maternal morbidity was higher for: older women, for instance 1.22 (1.13\u20131.33) for women aged 35\u201339\u2009years and 1.44 (1.27\u20131.63) for women aged &gt;\u200940\u2009years compared with those aged 25\u201329\u2009years; obese women, for instance 1.13 (1.06\u20131.21) for BMI 30\u201340\u2009kg.m\n                    <jats:sup>\u20102<\/jats:sup>\n                    and 1.32 (1.15\u20131.51) for BMI\u2009&gt;\u200940\u2009kg.m\n                    <jats:sup>\u20102<\/jats:sup>\n                    compared with BMI 18.5\u201324.9\u2009kg.m\n                    <jats:sup>\u20102<\/jats:sup>\n                    ; multiple pregnancy, 2.39 (2.09\u20132.74); and previous caesarean delivery, 1.52 (1.40\u20131.65). The median (IQR [range]) hospital stay was 3 (2\u20135 [1\u20138]) days with severe maternal morbidity and 2 (1\u20133 [1\u20135]) days without. Forty\u2010one women died during pregnancy or up to 42\u2009days after delivery, representing mortality rates per 100,000 pregnancies of about 365 with severe maternal morbidity and 1.6 without. There were 1449 women admitted to critical care, 807 (58%) for mechanical ventilation or support of at least two organs. We recorded an incidence of severe maternal morbidity higher than previously published, possibly because sepsis was coded inaccurately in our databases. Further research may determine the value of this composite measure of severe maternal morbidity.\n                  <\/jats:p>","DOI":"10.1111\/anae.15798","type":"journal-article","created":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T18:00:38Z","timestamp":1657648838000},"page":"971-980","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Severe maternal morbidity in Scotland"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1409-2164","authenticated-orcid":false,"given":"J. A.","family":"Masterson","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Adamestam","sequence":"additional","affiliation":[{"name":"Usher Institute University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Beatty","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Royal Infirmary of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3904-8960","authenticated-orcid":false,"given":"J. P.","family":"Boardman","sequence":"additional","affiliation":[{"name":"MRC Centre for Reproductive Health Queen's Medical Research Institute, University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Ninewells Hospital  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Joss","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Ninewells Hospital  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Litchfield","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Glasgow Royal Infirmary  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. S.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Royal Infirmary of Edinburgh  UK"},{"name":"Usher Institute University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Wise","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Royal Infirmary of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Wood","sequence":"additional","affiliation":[{"name":"Usher Institute University of Edinburgh  UK"},{"name":"Public Health Scotland  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6494-4903","authenticated-orcid":false,"given":"C. J.","family":"Weir","sequence":"additional","affiliation":[{"name":"Usher Institute University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. C.","family":"Denison","sequence":"additional","affiliation":[{"name":"MRC Centre for Reproductive Health Queen's Medical Research Institute, University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2707-2779","authenticated-orcid":false,"given":"N. I.","family":"Lone","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Pain Medicine Royal Infirmary of Edinburgh  UK"},{"name":"Usher Institute University of Edinburgh  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"EMBRRACE\u2010UK.Saving lives improving mothers' care lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016\u201318.2020.https:\/\/www.npeu.ox.ac.uk\/assets\/downloads\/mbrrace-uk\/reports\/maternal-report-2020\/MBRRACE-UK_Maternal_Report_Dec_2020_v10_ONLINE_VERSION_1404.pdf(accessed 20\/08\/ 2021)."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12802"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1089"},{"key":"e_1_2_6_5_1","article-title":"Severe maternal morbidity and mortality","volume":"3","author":"Rivara F","year":"2020","journal-title":"Journal of the American Medical Association Network Open"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.099"},{"key":"e_1_2_6_7_1","article-title":"Impact of severe maternal morbidity on adverse perinatal outcomes in high\u2010income countries: systematic review and meta\u2010analysis protocol","volume":"9","author":"Mengistu T","year":"2019","journal-title":"British Medical Journal Open"},{"key":"e_1_2_6_8_1","unstructured":"Centers for Disease Control and Prevention.Severe maternal morbidity in the United States.2019.https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/severematernalmorbidity.html(accessed 14\/08\/2021)."},{"key":"e_1_2_6_9_1","article-title":"Risk factors for maternal morbidity in Victoria, Australia: a population\u2010based study","volume":"5","author":"Lindquist A","year":"2015","journal-title":"British Medical Journal Open"},{"key":"e_1_2_6_10_1","unstructured":"Public Health Scotland.Births in Scottish Hospitals \u2010 24 November 2020 \u2010 data and intelligence from Public Health Scotland.2020.https:\/\/beta.isdscotland.org\/find-publications-and-data\/population-health\/births-and-maternity\/births-in-scottish-hospitals(accessed 16\/08\/2021)."},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogrm.2008.05.006"},{"key":"e_1_2_6_12_1","unstructured":"NSS Information and Intelligence.Assessment of SMR01 data 2014\u20132015 Scotland report.https:\/\/www.isdscotland.org\/Products-and-Services\/Data-Quality\/docs\/Assessment-of-SMR01-Data-2014-15-report-180508.pdf(accessed 21\/08\/2021)."},{"key":"e_1_2_6_13_1","unstructured":"NSS Information and Intelligence.Data quality assurance assessment of SMR02 (maternity inpatient and day case) data; 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