Important Facts for Severe maternal morbidity among hospital deliveries

Definition

The number of severe maternal morbidity events per 10,000 delivery hospitalizations

Numerator

The number of deliveries with an identified severe maternal morbidity event from delivery hospitalizations

Denominator

Total number of delivery hospitalizations

Data Interpretation Issues

Severe maternal morbidity (SMM) is defined by the Centers for Disease Control and Prevention as "unexpected outcomes of labor and delivery that result in significant short or long-term consequences to a woman's health." SMM is identified using a list of 16 diagnosis and 5 procedure [https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htm ICD codes]. Blood transfusion codes are the most common procedure used to define SMM and some researchers choose to exclude these codes if there are not accompanied by other diagnosis or procedure codes. National and comparative state estimates of SMM are provided by the Healthcare Cost and Utilization Project (HCUP) and do not include transfusions. However, for historical purposes, Utah-specific rates by age group, race, ethnicity, LHD, and payer type do include transfusion codes in defining SMM. Births that occur in freestanding birth centers and private homes are not included in the data. The proportion of Utah births that occur in an out-of-hospital setting was 4% in 2021 and has been increasing over the past several years.

Why Is This Important?

Every year, there are approximately 46,000 births to Utah residents. Most births do not result in complications to the mother or child, but some women suffer from "near-misses" or unexpected outcomes during labor and delivery, also called severe maternal morbidities (SMM). These outcomes include hemorrhage, eclampsia, renal failure, acute myocardial infarction, shock, and other severe complications. SMM can have mild to long-lasting effects on the physical and mental health of women experiencing it. Maternal morbidity is also emerging as an important measure in efforts to prevent maternal mortality and address [https://doi.org/10.26099/r43h-vh76 maternal health inequities]. The rate of SMM has been increasing steadily at the [https://datatools.ahrq.gov/hcup-fast-stats/?type=subtab&tab=hcupfsse&count=3 national and state levels]. Specifically, the rate of SMM per 10,000 in-hospital deliveries increased from 71.9 in 2013 to 88.2 in 2020 nationally. Utah has experienced a similar increase with a rate of 48.8 in 2013 and 61.3 in 2020. The comparison of SMM rates between Utah and the U.S. does not include transfusion codes when defining SMM. However for historical purposes, Utah-specific rates by age group, race, ethnicity, LHD, and payer type do include transfusion codes in defining SMM. In addition to the physical and emotional toll SMM has on women and their families, the [https://pubmed.ncbi.nlm.nih.gov/31655962/ financial costs] associated with SMM are significant. Births involving severe maternal morbidity are much more expensive than those without SMM. The [https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf White House Blueprint for Addressing the Maternal Health Crisis] calls for supporting state innovation efforts by establishing state-focused Maternal Health Task Forces and improving state-level surveillance on maternal mortality and SMM. Surveillance of SMM in Utah will help health practitioners understand the current state of SMM in Utah, identify risk factors, and develop programs to help prevent severe maternal morbidities.

How Do We Compare With the U.S.?

Compared to the U.S. as a whole, the rate of SMM in Utah has historically been lower. However, it has been increasing at both the state and national levels. Currently, Utah ranks 4th in the nation, meaning that Utah has the fourth lowest rate of SMM compared to other states.

What Is Being Done?

The Utah Department of Health and Human Services collaborates with the [https://www.saferbirth.org Alliance for Innovation on Maternal Health (AIM)] to prevent severe maternal morbidity and mortality through the use of Patient Safety Bundles in participating facilities. Patient Safety Bundles are evidence-based toolkits meant to improve the processes of care and patient outcomes. Since becoming an AIM participating state, as many as 33 out of 46 birthing facilities in Utah have participated in at least one Safety Bundle, which accounts for approximately 70% of Utah births. Utah birthing facilities have implemented the following Safety Bundles: Obstetric Hemorrhage, Severe Hypertension, and Care for Pregnant Postpartum People with Substance Use Disorders. Utah's Perinatal Mortality Review Committee consists of clinical and public health professionals and meets monthly to review infant and maternal deaths. The Committee reviews de-identified information from death certificates, birth certificates, medical records, autopsy reports, and other resources to determine whether the deaths were preventable. An important goal of the committee is to craft recommendations to prevent future deaths. Recommendations are made at the patient, family, provider, facility, community, and system level to prevent future morbidity and mortality.