Ranked Severe Maternal Morbidity Index for Population-Level Surveillance by Mode of Delivery
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective: To determine which severe maternal morbidity indicators identify the most in-hospital mortality during delivery hospitalization by delivery mode. Materials and Methods: We obtained data from the 1993–2015 Healthcare Cost and Utilization Project’s 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. Results: 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 “died,” 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: cardiac arrest/ventricular fibrillation, conversion of cardiac rhythm, ventilation, temporary tracheostomy, and aneurysm . Among vaginal deliveries, the top five ranked indicators were as follows: conversion of cardiac rhythm, cardiac arrest/ventricular fibrillation, ventilation, temporary tracheostomy, and amniotic fluid embolism . 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. Conclusion: 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.
Source: Journal of Women s Health
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7125801134