Research
Obstetrics
Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003

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Objective

This investigation aimed to identify pregnancy complications and risk factors for women who experienced severe maternal morbidity during the delivery hospitalization and to estimate severe maternal morbidity rates.

Study Design

We used the National Hospital Discharge Survey for 1991-2003 to identify delivery hospitalizations with maternal diagnoses and procedures that indicated a potentially life-threatening diagnosis or life-saving procedure.

Results

For 1991-2003, the severe maternal morbidity rate in the United States was 5.1 per 1000 deliveries. Most women who were classified as having severe morbidity had an ICD-9-CM code for transfusion, hysterectomy, or eclampsia. Severe morbidity was more common at the extremes of reproductive age and for black women, compared with white women.

Conclusion

Severe maternal morbidity is 50 times more common than maternal death. Understanding these experiences of these women potentially could modify the delivery of care in healthcare institutions and influence maternal health policy at the state and national level.

Section snippets

Materials and Methods

We used information from the National Hospital Discharge Survey (NHDS) for the years 1991-2003 to identify delivery hospitalizations. This time period was chosen because it reflected the most recent design of the survey and encompassed a large number of deliveries, thereby allowing for exploration of trends in relatively rare events. The NHDS is conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics, and its design is described in detail

Results

From 1991 through 2003, the NHDS contained 423,480 sampled records in which a delivery was indicated by the presence of a V27 code in the primary diagnosis field; the sample represented 50.6 million deliveries when the appropriate weighting was applied. In the same time period, there were 2235 discharge records for delivery hospitalizations with a length of stay of at least 3 days and at least 1 diagnosis or procedure code that met the severe maternal morbidity criteria; these records represent

Comment

Deaths of women as a consequence of pregnancy in the United States have been likened to “the tip of the iceberg”; that is, for every death, there are many women who have significant complications of pregnancy, labor, and delivery. During the period 1991-2003, we found that 5 of every 1000 women who delivered had at least 1 indicator of a severe complication during their delivery hospitalization. For every maternal death, approximately 50 women experience severe morbidity, which means that

References (29)

  • S.W. Wen et al.

    Severe maternal morbidity in Canada, 1991-2001

    CMAJ

    (2005)
  • C. Dennison et al.

    Design and operation of the National Hospital Discharge Survey: 1988 redesign

    Vital Health Stat 1

    (2000)
  • M.J. Hall et al.

    1998 Summary: National Hospital Discharge Survey; advance data from vital and health statistics; No. 316

    (2000)
  • J.R. Popovic et al.

    1999 National Hospital Discharge Survey; advance data from vital and health statistics; No. 319

    (2001)
  • Cited by (0)

    Cite this article as: Callaghan WM, MacKay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003. Am J Obstet Gynecol 2008;199:133.e1-133.e8.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers of Disease Control and Prevention.

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