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Severe maternal morbidity definitions based on hospital billing codes in Canada, Finland, and Australia

Severe maternal morbidity definitions based on hospital billing codes in Canada, Finland, and Australia
Canada[1]
Diagnoses (ICD-9)
  • Venous thromboembolism
  • Eclampsia
  • Pulmonary, cardiac, and central nervous system complications of anesthesia
  • Cerebrovascular disorders in the puerperium, including intracranial venous sinus thrombosis
  • Uterine rupture
  • Adult respiratory distress syndrome
  • Pulmonary edema
  • Myocardial infarction
  • Acute renal failure after labor and delivery
  • Cardiac arrest or failure or cerebral anoxia after obstetric surgery
  • Severe postpartum hemorrhage requiring hysterectomy, transfusion, or both
Procedures (Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures [CPP])
  • Ventilation
  • Transfusion
  • Abdominal hysterectomy
Finland[2]
Diagnoses (ICD-10)
  • Thromboembolic disease
  • Hemorrhage
  • Infections
  • Intestinal obstruction
  • Uterine rupture
  • Uterine inversion
Operative interventions (Nordic Classification of Surgical Procedures)
  • Hysterectomy (total and subtotal)
  • Reoperations (repair of wound dehiscence, deep infection, deep hemorrhage, insufficiency of anastomosis or suture, exploratory laparotomy, other)
Australia[3]
Diagnoses (ICD-10)
  • Acute abdomen
  • Acute renal failure
  • Acute psychosis
  • Cardiac arrest, failure, or infarction
  • Cerebral edema or coma
  • Disseminated intravascular coagulation
  • Cerebrovascular accident
  • Major complications of anesthesia
  • Obstetric embolism
  • Shock
  • Sickle cell anemia crisis
  • Status asthmaticus
  • Status epilepticus
  • Uterine rupture
Procedures (Australian Classification of Health Interventions ICD-10 Procedure Codes)
  • Assisted ventilation
  • Curettage in combination with general anesthetic
  • Dialysis
  • Evacuation of hematoma
  • Hysterectomy
  • Procedures to reduce blood flow to uterus
  • Reclosure of disrupted cesarean wound
  • Repair of bladder
  • Repair of intestine
  • Repair of ruptured or inverted uterus
  • Transfusion of blood or coagulation factors
ICD: International Classification of Diseases.
References:
  1. Wen SW, Huang L, Liston R, et al. Severe maternal morbidity in Canada, 1991-2001. CMAJ 2005; 173:759.
  2. Pallasmaa N, Ekblad U, Gissler M. Severe maternal morbidity and the mode of delivery. Acta Obstet Gynecol Scan 2008; 87:662.
  3. Robert CL, Cameron CA, Bell JC, et al. Measuring maternal morbidity in routinely collected health data: development and validation of a maternal morbidity outcome indicator. Med Care 2008; 46:786.
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