{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:33:45Z","timestamp":1791513225536,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T00:00:00Z","timestamp":1565568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PER-150902"],"award-info":[{"award-number":["PER-150902"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is no international consensus on the definition and components of severe maternal morbidity (SMM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To propose a comprehensive definition of SMM, to create an empirically justified list of SMM types and subtypes, and to use this to examine SMM in Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Severe maternal morbidity was defined as a set of heterogeneous maternal conditions known to be associated with severe illness and with prolonged hospitalisation or high case fatality. Candidate SMM types\/subtypes were evaluated using information on all hospital deliveries in Canada (excluding Quebec), 2006\u20102015. SMM rates for 2012\u20102016 were quantified as a composite and as SMM types\/subtypes. Rate ratios and population attributable fractions (PAF) associated with overall and specific SMM types\/subtypes were estimated in relation to length of hospital stay (LOS\u00a0&gt;\u00a07\u00a0days) and case fatality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 22\u00a0799 cases of SMM subtypes (among 1\u00a0418\u00a0545 deliveries) that were associated with a prolonged LOS or high case fatality. Between 2012 and 2016, the composite SMM rate was 16.1 (95% confidence interval [CI] 15.9, 16.3) per 1000 deliveries. Severe pre\u2010eclampsia and HELLP syndrome (514.6 per 100\u00a0000 deliveries), and severe postpartum haemorrhage (433.2 per 100\u00a0000 deliveries) were the most common SMM types, while case fatality rates among SMM subtypes were highest among women who had cardiac arrest and resuscitation (241.1 per 1000), hepatic failure (147.1 per 1000), dialysis (67.6 per 1000), and cerebrovascular accident\/stroke (51.0 per 1000). The PAF for prolonged hospital stay related to SMM was 17.8% (95% CI 17.3, 18.3), while the PAF for maternal death associated with SMM was 88.0% (95% CI 74.6, 94.4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The proposed definition of SMM and associated list of SMM subtypes could be used for standardised SMM surveillance, with rate ratios and PAFs associated with specific SMM types\/subtypes serving to inform clinical practice and public health policy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12574","type":"journal-article","created":{"date-parts":[[2019,8,13]],"date-time":"2019-08-13T06:59:38Z","timestamp":1565679578000},"page":"427-439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":100,"title":["Severe maternal morbidity surveillance: Monitoring pregnant women at high risk for prolonged hospitalisation and death"],"prefix":"10.1111","volume":"34","author":[{"given":"Susie","family":"Dzakpasu","sequence":"first","affiliation":[{"name":"Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paromita","family":"Deb\u2010Rinker","sequence":"additional","affiliation":[{"name":"Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Arbour","sequence":"additional","affiliation":[{"name":"Department of Medical Genetics University of British Columbia Victoria BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth K.","family":"Darling","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5977-8461","authenticated-orcid":false,"given":"Michael S.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and of Epidemiology and Biostatistics McGill University Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiliang","family":"Liu","sequence":"additional","affiliation":[{"name":"Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Luo","sequence":"additional","affiliation":[{"name":"Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil A.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Perinatal Program of Newfoundland and Labrador St. John\u2019s NFL Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Nelson","sequence":"additional","affiliation":[{"name":"Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research Public Health Agency of Canada Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel G.","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Dalhousie University Halifax NS Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"VandenHof","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Dalhousie University Halifax NS Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5607","authenticated-orcid":false,"given":"K. S.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/72.1.241S"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.8.1312"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780195387902.003.0054"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00303.x"},{"issue":"133","key":"e_1_2_7_6_1","first-page":"e1","article-title":"Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991\u20132003","volume":"199","author":"Callaghan WM","year":"2008","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-7"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)34656-4"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0527-2"},{"key":"e_1_2_7_10_1","volume-title":"Public Health Agency of Canada","author":"Canadian Perinatal Health Report","year":"2008"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03403698"},{"issue":"557","key":"e_1_2_7_12_1","first-page":"e1","article-title":"Preventability of severe acute maternal morbidity","volume":"210","author":"Lawton B","year":"2014","journal-title":"Am J Obs Gynecol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02480.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1280856"},{"key":"e_1_2_7_15_1","first-page":"74","article-title":"Preventing maternal morbidity from obstetric hemorrhage: implications of a provider training initiative","volume":"34","author":"Kominiarek MA","year":"2017","journal-title":"Am J Perinatol"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-1-3"},{"key":"e_1_2_7_17_1","unstructured":"Evaluating the quality of care for severe pregnancy complications.The WHO near\u2010miss approach for maternal health.Geneva:World Health Organization.2011. 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