Evidence map›Paper›PMID 31407359›Full record

ArticlePaediatric and perinatal epidemiology2020

Severe maternal morbidity surveillance: Monitoring pregnant women at high risk for prolonged hospitalisation and death.

Susie Dzakpasu, Paromita Deb-Rinker, Laura Arbour, Elizabeth K Darling, Michael S Kramer, Shiliang Liu, Wei Luo, Phil A Murphy, Chantal Nelson, Joel G Ray and 3 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Paediatric and perinatal epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05461183 (Assessment of Cumulative Incidence and Factors Associated With Hospital Re-admission and Severe Maternal Morbidity After Delivery Discharge in British Columbia), which is not on this map. Cited by 59 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
59citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05461183 unknown statusnot on this map

Assessment of Cumulative Incidence and Factors Associated With Hospital Re-admission and Severe Maternal Morbidity After Delivery Discharge in British Columbia

TypeobservationalSponsorUniversity of British ColumbiaRan2008 to 2023Enrolled15,000ConditionsMorbidity, Perinatal, Pregnancy Complications, Pregnancy RelatedArmsRetrospective database analysis
3 · Its place in the literature

Who cites it

59 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Racial inequities in severe maternal morbidity among Black and White people in Canada: a population-based cohort study, 2012 to 2023.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  4. Article
  5. Hysterectomy for placenta accreta spectrum disorder: Impact of institutional surgical volume on patient outcomes.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Article
  6. Article
  7. Review
  8. Maternal morbidity following a trial of labor after cesarean birth: A scoping review of operative vaginal birth compared with cesarean birth in the second stage of labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Article
  9. Article
  10. Observational
  11. Article
  12. Adequacy of Prenatal Care and Ensuing Maternal and Neonatal Severe Morbidity and Mortality.BJOG : an international journal of obstetrics and gynaecology · 2026
    Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Observational
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Susie DzakpasuMaternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
Paromita Deb-RinkerMaternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
Laura ArbourDepartment of Medical Genetics, University of British Columbia, Victoria, BC, Canada.
Elizabeth K DarlingDepartment of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
Michael S KramerDepartment of Pediatrics and of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada.ORCID 0000-0002-5977-8461
Shiliang LiuMaternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
Wei LuoMaternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
Phil A MurphyPerinatal Program of Newfoundland and Labrador, St. John's, NFL, Canada.
Chantal NelsonMaternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
Joel G RayDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Heather ScottDepartment of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada.
Michiel VandenHofDepartment of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS, Canada.
K S JosephDepartment of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.ORCID 0000-0003-2317-5607

Funding

CIHR PER-150902
6 · The paper itself

Abstract

backgroundThere is no international consensus on the definition and components of severe maternal morbidity (SMM).

objectivesTo 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.

methodsSevere 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), 2006-2015. SMM rates for 2012-2016 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 > 7 days) and case fatality.

resultsThere were 22 799 cases of SMM subtypes (among 1 418 545 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-eclampsia and HELLP syndrome (514.6 per 100 000 deliveries), and severe postpartum haemorrhage (433.2 per 100 000 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).

conclusionsThe 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.

Indexed as

Maternal MortalityObstetric Labor ComplicationsPregnancy ComplicationsPregnancy, High-RiskAdultCanadaCause of DeathEpidemiological MonitoringFemaleHumansLength of StayMortalityOutcome Assessment, Health CarePregnancyPublic Health SurveillanceRisk Factorsmaternal mortalitysevere maternal morbiditysurveillance

Identifiers

PMID31407359
PMCPMC7383693

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.