{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T08:26:06Z","timestamp":1787127966002,"version":"build-2736575974"},"reference-count":35,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine which severe maternal morbidity indicators identify the most in-hospital mortality during delivery hospitalization by delivery mode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We obtained data from the 1993\u20132015 Healthcare Cost and Utilization Project\u2019s National Inpatient Sample. Separate analyses were conducted for cesarean and vaginal deliveries. We ranked 22 severe maternal morbidity indicators by their overall population-attributable fraction of in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We identified 87,864,173 delivery hospitalizations; 27.9% were cesarean deliveries and 72.1% were vaginal deliveries. There were 6,686 records with a discharge disposition of \u201cdied,\u201d with the most occurring for cesarean deliveries (71.2%). Most deaths had a severe maternal morbidity indicator (cesarean deliveries = 94.2%; vaginal deliveries = 73.5%). Among cesarean deliveries, the top five ranked indicators were as follows:\n                      <jats:italic toggle=\"yes\">cardiac arrest\/ventricular fibrillation, conversion of cardiac rhythm, ventilation, temporary tracheostomy,<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">aneurysm<\/jats:italic>\n                      . Among vaginal deliveries, the top five ranked indicators were as follows:\n                      <jats:italic toggle=\"yes\">conversion of cardiac rhythm, cardiac arrest\/ventricular fibrillation, ventilation, temporary tracheostomy,<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">amniotic fluid embolism<\/jats:italic>\n                      . The top three ranked indicators identified 78.8% of in-hospital mortality among cesarean deliveries and 66.0% of in-hospital mortality among vaginal deliveries.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Severe maternal morbidity indicator rankings for cesarean and vaginal deliveries were similar; however, there were differences by delivery mode in the performance of the SMM indicators in identifying in-hospital deaths. Our findings underscore the need for the improved documentation and measurement of severe obstetric complications during pregnancy and the postpartum period at the population level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15409996251405046","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T07:09:21Z","timestamp":1769497761000},"page":"473-481","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ranked Severe Maternal Morbidity Index for Population-Level Surveillance by Mode of Delivery"],"prefix":"10.1177","volume":"35","author":[{"given":"Lindsay S.","family":"Womack","sequence":"first","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romeo R.","family":"Galang","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay K.","family":"Admon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA."},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Clark","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C.","family":"Ewing","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen A.","family":"Satten","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Y.","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."},{"name":"United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia D.","family":"Ferre","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlan D.","family":"Kroelinger","sequence":"additional","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"World Health Organization. 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