Skip to main content

Table 1 Estimates of the Prevalence of Severe Maternal Morbidity in High-Income Countries

From: A global view of severe maternal morbidity: moving beyond maternal mortality

Author (Year) Country Definition of SMM Estimated Prevalencea Leading Causes
Bouvier-Colle (2012) [13] 17 EU Countries Eclampsia 0.2–1.6  
  3 EU Countries ICU Admission 0.5–3.1  
  10 EU Countries Blood Transfusion 0.1–11.5  
  15 EU Countries Hysterectomy 0.2–1.0  
  7 EU Countries Embolisation 0.0–0.3  
Colmorn (2015) [71] Denmark, Finland, Iceland, Norway, and Sweden Complete uterine rupture 5.6  
Deneux-Tharaux (2017) [16] France Obstetric hemorrhage, hypertensive complications,
Psychiatric disorder, decompensation of preexisting condition, pulmonary embolism, sepsis, stroke, amniotic fluid embolism, other
13.9 Obstetric hemorrhage (65.2%), hypertensive conditions (21.6%)
Jayaratnam (2016) [45] Australia WHO criteria 4.8 Hemorrhage
Jayaratnam (2011) [72] Australia Antepartum hemorrhage requiring emergency surgery, PPH requiring surgery, any postnatal patient requiring surgery, severe pre-eclampsia/eclampsia/HELLP,
ICU admission, shock, acute ruptured ectopic, pulmonary embolism, other conditions requiring immediate medical assessment
6.0  
Kilpatrick (2016) [43] United States CDC method with chart review to confirm condition was truly life-threatening 7.3 Hemorrhage, hypertensive disorders
Lawton (2016) [personal communication] New Zealand ICU/HDU admission 6.2 Major blood loss, pre-eclampsia, sepsis
Lyndon (2012) [73] United States CDC method supplemented with birth certificate data 5.8  
Main (2016) [74] United States “Gold standard” clinical guidelines 7.3  
Marr (2014) [40] Scotland Major obstetric hemorrhage, eclampsia, renal or liver dysfunction, pulmonary edema, acute respiratory distress, coma, cerebrovascular event, status epilepticus, anaphylactic shock, septicemic shock, anesthetic problem, massive pulmonary embolism, ICU/coronary care unit admission 6.1 Major obstetric hemorrhage, ICU/coronary care admission
Nair (2016) [20] England Acute abdomen 0.01  
   Acute renal failure 0.08  
   Acute psychosis 0.05  
   Cardiac arrest/failure or infarction 0.05  
   Cerebral edema or coma 0.01  
   DIC 0.01  
   Cerebrovascular accident 0.04  
   Major complications of anesthesia 0.06  
   Obstetric embolism (inc. AFE) 0.27  
   Shock 0.20  
   Sickle cell crisis 0.05  
   Status asthmaticus 0.02  
   Status epilepticus 0.03  
   Uterine rupture 0.48  
   Eclampsia 0.71  
   Sepsis 0.44  
   Cerebral venous thrombosis 0.003  
   Assisted ventilation including tracheostomy 0.15  
   Curettage with general anesthesia 0.01  
   Dialysis 0.01  
   Evacuation of hematoma 0.50  
   Hysterectomy 0.24  
   Procedures to reduce blood flow to uterus 0.06  
   Re-closure of disrupted cesarean section wound 0.31  
   Repair of bladder or cystostomy 0.31  
   Repair of intestine 0.008  
O’Malley (2016) [75] Ireland WHO criteria 3.6 Hemorrhage
   Scottish Audit of SMM criteria 18.4 Hypertension
Ozimek (2016) [37] United States “Gold standard” clinical guidelines from Main (2016) 9.2 Hemorrhage, preeclampsia/eclampsia
Zanconato (2012) [44] Italy ICU admission, transfusion ≥4 units, emergency peripartum hysterectomy, arterial embolization 8.5 Hypertensive disorders, hemorrhage, sepsis
Zwart (2010) [76] The Netherlands ICU admission, eclampsia/HELLP syndrome, uterine rupture, major hemorrhage, miscellaneous 7.1 overall
6.3 Western ethn
8.4 non-Western ethn
 
   Peripartum hysterectomy 3.5  
   Abnormally invasive placenta 4.6  
   Severe hemorrhage at delivery 11.6  
  1. aPer 1000 live births