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Facility-Based Identification of Women With Severe Maternal Morbidity: It Is Time to Start

Callaghan, William M. MD, MPH; Grobman, William A. MD, MBA; Kilpatrick, Sarah J. MD, PhD; Main, Elliott K. MD; D'Alton, Mary MD

doi: 10.1097/AOG.0000000000000218
Contents: Current Commentary

Although maternal deaths have been the traditional indicator of maternal health, these events are the “tip of the iceberg” in that there are many women who have significant complications of pregnancy, labor, and delivery. Identifying women who experience severe maternal morbidity and reviewing their care can provide critical information to inform quality improvement in obstetrics. In this commentary, we review methods to identify women who experienced severe complications of pregnancy. We propose a simple validated approach based on transfusion of four or more units of blood products, admission to an intensive care unit, or both as a starting point for identification and review of severe maternal morbidity in health care settings for the purpose of understanding successes and failures in systems of care.

Facility-based identification of women with severe maternal morbidity and review of their care can further efforts to improve the quality of obstetric care.

Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; the Departments of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Cedars-Sinai Medical Center, Los Angeles, California, and Columbia University College of Physicians and Surgeons, New York, New York; and the California Maternal Quality Care Collaborative, Palo Alto, California.

Corresponding author: William M. Callaghan, MD, MPH, Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-74, Atlanta, GA 30341; e-mail:

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

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.