University of Wisconsin–Madison Medical College of Wisconsin

Severe Maternal Morbidity During Delivery Hospitalizations in Wisconsin

Crystal Gibson, MPH; Angela M. Rohan, PhD; Kate H. Gillespie, RN

WMJ. 2017;116(4):259-264.

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Introduction: Severe maternal morbidities include 25 complications resulting from, or exacerbated by, pregnancy. Nationally, in the last decade, these rates have doubled.

Objective: This study describes trends in the rates of severe maternal morbidities at the time of hospitalization for delivery among different groups of Wisconsin women.

Methods: Hospital discharge data and ICD-9-CM diagnosis and procedure codes were used to identify delivery hospitalizations and rates of severe maternal morbidity among Wisconsin women from 2000 to 2014. Subsequent analyses focused on recent years (2010-2014). Rates of severe maternal morbidity were calculated per 10,000 delivery hospitalizations for all 25 severe maternal morbidity conditions as well as 24 conditions (excluding blood transfusions). Rates and rate ratios were calculated overall and for racial/ethnic groups, age groups, public health region of residence, and hospital payer. Median hospital length of stay and median hospital charges were compared for delivery hospitalizations with increasing severe maternal morbidities.

Results: Severe maternal morbidity rates increased 104% from 2000 to 2014 (P for trend <0.01). After excluding blood transfusions, rates increased 15% (P for trend <0.05). From 2010 to 2014, overall rates were stable over time, but varied by maternal age, race/ethnicity, payer, and public health region of residence. Median hospital charges and length of stay increased as the number of morbidities increased.

Conclusions: Monitoring severe maternal morbidities adds valuable information to understanding perinatal health and obstetric complications in order to identify opportunities for prevention of severe morbidities and improvements in the quality of maternity care.

Author Affiliations: Wisconsin Department of Health Services, Division of Public Health, Madison, Wis (Rohan, Gillespie); Public Health Madison and Dane County, Madison, Wis (Gibson); Centers for Disease Control and Prevention, Madison, Wis (Rohan).
Corresponding Author: Angela Rohan, PhD, Centers for Disease Control and Prevention; 1 W Wilson St, Room 233, Madison, WI 53703; phone 608.267.0241; fax 608.266.8925; email
Acknowledgements: The authors would like to thank Kristin Rankin, PhD, Michael Schellpfeffer, MD, and the Wisconsin Maternal Mortality Review Team for their input and assistance during preparation of this manuscript.
Author Disclosures: None declared.
Funding/Support: This study was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention Cooperative Agreement Number 1U38OT000143-03. 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.
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