For a study, researchers sought to determine if using a standard approach to prenatal and postpartum (42-day) hospitalizations improved the detection of severe maternal morbidity (SMM) beyond only looking at the birth event. The PELL (Pregnancy to Early Life Longitudinal) database, a Massachusetts population-based data system that links records from birth certificates through delivery hospital discharge records and non-birth hospital records for all birthing persons, was used in a retrospective cohort research. Researchers looked at deliveries from January 1, 2009, to December 31, 2018, separating the International Classification of Diseases Ninth (ICD-9) from the International Classification of Diseases Tenth Revision (ICD-10) coding. They utilized the Alliance for Innovation in Maternal Health’s modified Centers for Disease Control and Prevention SMM methodology to hospitalizations from the prenatal period to 42 days postpartum. Morbidity was assessed with and without blood transfusion.
Overall, 594,056 deliveries were included in the analysis, with 3,947 meeting criteria for SMM at delivery without transfusion and 9,593 meeting criteria with transfusion, for aggregate rates of 150.1 (95% CI 146.7–153.5) using ICD-9 codes and 196.6 (95% CI 189.5–203.7) using ICD-10 codes per 10,000 deliveries. Severe maternal morbidity at delivery grew gradually across both ICD-9 and ICD-10, rising from 129.4 per 10,000 in 2009 (95% CI 126.2–132.6) using ICD-9 to 214.3 per 10,000 (95% CI 206.9–221.8) in 2018. Including prenatal and postpartum hospitalizations increased cases by 21.9% in both ICD-9 and ICD-10, yielding a 2018 rate of 258.7 per 10,000 (95% CI 250.5–266.9). Sepsis cases were responsible for the greatest increase in identified morbidity during the prenatal or postpartum period.
The inclusion of prenatal and postpartum hospitalizations in the diagnosis of SMM resulted in enhanced morbid event detection. The findings showed that there was a need to ensure that care quality actions are monitored after the delivery event.