{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T06:11:05Z","timestamp":1783836665560,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,1,28]],"date-time":"2019-01-28T00:00:00Z","timestamp":1548633600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001505","name":"Health Research Council of New Zealand","doi-asserted-by":"publisher","award":["13\/CEN\/96"],"award-info":[{"award-number":["13\/CEN\/96"]}],"id":[{"id":"10.13039\/501100001505","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Severe maternal morbidity (<jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content>) is rising globally. Assessing <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> is an important quality measure. This study aimed to examine <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> in a national cohort in New Zealand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This is a national retrospective review of pregnant or postpartum women admitted to an Intensive Care Unit or High Dependency Unit during pregnancy or recent postpartum. Outcomes were rates of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> and assessment of potential preventability. Preventability was defined as any action on the part of the provider, system or patient that may have contributed to progression to more severe morbidity, and was assessed by a multidisciplinary review team.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Severe maternal morbidity was 6.2 per 1000 deliveries (95% confidence interval 5.7\u20106.8) with higher rates for Pacific, Indian and other Asian racial groups. Major blood loss (39.4%), preeclampsia\u2010associated conditions (23.3%) and severe sepsis (14.1%) were the most common causes of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content>. Potential preventability was highest with sepsis cases (56%) followed by preeclampsia and major blood loss (34.3% and 30.9%). Of these cases, only 36.4% were managed appropriately as determined by multidisciplinary review. Provider factors such as inappropriate diagnosis, delay or failure to recognize high risk were the most common factors associated with potential preventability of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content>. Pacific Island women had over twice the rate of preventable morbidity (relative risk\u00a02.48, 95% confidence interval 1.28\u20134.79).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multidisciplinary external anonymized review of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> showed that over a third of cases were potentially preventable, being due to substandard provider care with increased preventability rates for racial\/ethnic minority women. Monitoring country rates of <jats:styled-content style=\"fixed-case\">SMM<\/jats:styled-content> and implementing case reviews to assess potential preventability are appropriate quality improvement measures and external review of anonymized cases may reduce racial profiling to inform unbiased appropriate interventions and resource allocation to help prevent these severe events.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13526","type":"journal-article","created":{"date-parts":[[2018,12,26]],"date-time":"2018-12-26T15:59:47Z","timestamp":1545839987000},"page":"515-522","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Preventability review of severe maternal morbidity"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2447-8386","authenticated-orcid":false,"given":"Beverley A.","family":"Lawton","sequence":"first","affiliation":[{"name":"Center for Women's Health Research Te T\u0101tai Hauora O Hine Faculty of Health Victoria University of Wellington Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9307-2323","authenticated-orcid":false,"given":"E.","family":"Jane MacDonald","sequence":"additional","affiliation":[{"name":"Center for Women's Health Research Te T\u0101tai Hauora O Hine Faculty of Health Victoria University of Wellington Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8572-1047","authenticated-orcid":false,"given":"James","family":"Stanley","sequence":"additional","affiliation":[{"name":"Dean's Department University of Otago Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Daniells","sequence":"additional","affiliation":[{"name":"Hutt Valley District Heath Board Lower Hutt New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7557-7184","authenticated-orcid":false,"given":"Stacie E.","family":"Geller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Illinois Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,28]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Evaluating the Quality of Care for Severe Preganancy Complications: The WHO Near\u2010miss Approach for Maternal Health","author":"World Health Organization","year":"2011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.12.020"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2013.4617"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000218"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2009.01.004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.11.039"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","unstructured":"KnightM AcostaC BrocklehurstP et\u00a0al.Beyond Maternal Death: Improving the Quality of Maternal Care Through National Studies of \u2018Near\u2010miss\u2019 Maternal Morbidity. Programme Grants for Applied Research No. 4.9.Southampton:NIHR Journals Library;2016.","DOI":"10.3310\/pgfar04090"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1552-6909.12478"},{"key":"e_1_2_9_10_1","volume-title":"MBRRACE\u2010UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK","author":"National Perinatal Epidemiology Unit","year":"2016"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.06.046"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2011.3398"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2217\/WHE.14.80"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2016.03.034"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.01.003"},{"key":"e_1_2_9_16_1","unstructured":"Maternity Tables[Internet].Ministry of Health.2014.https:\/\/www.health.govt.nz\/publication\/report-maternity-2014. Accessed August 16 2016."},{"key":"e_1_2_9_17_1","volume-title":"Guidelines for Consultation with Obstetric and Related Medical Services (Referral Guidelines)","author":"Ministry of Health","year":"2012"},{"key":"e_1_2_9_18_1","volume-title":"National Health Index","author":"New Zealand Health Information Service","year":"2017"},{"key":"e_1_2_9_19_1","unstructured":"SalmondC CramptonP AtkinsonJ.NZDep2006 Index of Deprivation: Department of Public Health.Wellington:University of Otago;2007."},{"key":"e_1_2_9_20_1","volume-title":"Tenth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting Mortality 2014","author":"Perinatal and Maternal Mortality Review Committee","year":"2016"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211432"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.12.032"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.07.052"},{"issue":"01","key":"e_1_2_9_24_1","first-page":"021","article-title":"Validation of a scoring system to identify women with near\u2010miss maternal morbidity","volume":"30","author":"You WB","year":"2013","journal-title":"Am J Perinatol"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280210395740"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v009.i08"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302903"},{"issue":"1","key":"e_1_2_9_28_1","first-page":"1","article-title":"The eighth report on confidential enquiries into maternal deaths in the United Kingdom","volume":"118","author":"Cantwell R","year":"2011","journal-title":"BJOG"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12160"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.05.022"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.07.004"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Faogs.13526","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.13526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T04:14:57Z","timestamp":1694492097000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.13526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,28]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1111\/aogs.13526"],"URL":"https:\/\/doi.org\/10.1111\/aogs.13526","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,28]]},"assertion":[{"value":"2018-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}