Findings From Severe Maternal Morbidity Surveillance and Review in Maryland



eFigure 1 .

 1 Severe Maternal Morbidity Surveillance Definition Notes: ICU, intensive care unit; CCU, critical care unit; RBC, red blood cell. eFigure 2. Timing of Severe Maternal Morbidity Events a. All SMM Events (N=192) b. Excluding COVID-19 (N=134) Notes: ICU, intensive care unit. SMM events include patients during pregnancy or within 42 days postpartum who are (a) admitted to an intensive care unit or critical care unit; and/or (b) with 4 or more units of red blood cells transfused; and/or (c) admitted to hospital for treatment of COVID-19 infection. Data source: Maryland SMM Surveillance and Review Database. 




  C et al. JAMA Network Open. 




  Gestational Age at the Time of Antepartum and Intrapartum SMM Events a. All SMM Events (N=192) 


	eFigure 3.				
	100%				
	80%				
	60%				
	40%				
	20%				
	0%				
	All SMM Events (N=192)	ICU Admission (N=107)	Blood Transfusion (N=92) COVID-19 Infection (N=60)
	Antepartum	Intrapartum	Postpartum <8hrs		Postpartum 8-72h	Postpartum >72h
	100%				
	80%				
	60%				
	40%				
	20%				
	0%				
	All SMM Events (N=134)		ICU Admission (N=83)	Blood Transfusion (N=90)
	Antepartum	Intrapartum	Postpartum <8hrs	Postpartum 8-72h	Postpartum >72h

b. ExcludingNotes: ICU, intensive care unit. Four SMM events occurred prior to 20 weeks' gestation. SMM events include patients during pregnancy or within 42 days postpartum who are (a) admitted to an intensive care unit or critical care unit; and/or (b) with 4 or more units of red blood cells transfused; and/or (c) admitted to hospital for treatment of COVID-19 infection. Data source: Maryland SMM Surveillance and Review Database. 
eTable 1 .

 1 Blood Loss and Transfusion in Patients With SMM by Primary Cause Distribution of Primary Cause of Severe Maternal Morbidity in Surveillance and Non-Surveillance Hospitals, 2019 Chi-square of difference in distribution of primary SMM cause between pilot and non-pilot hospital in 2019. Data source: Maryland SMM Surveillance and Review Database; Agency for Healthcare Research and Quality's Maryland State Inpatient Databases during 2019. 


	eTable 3. Primary Cause of SMM Hemorrhage	All SMM Events (N=192) Non-Pilot (N=47,825) No. 176 49.2 %	Obstetric Hemorrhage (N=83) Pilot (N=16,031) COVID-19 Infection No. % (N=57) 64 42.7	Hypertensive Disorder of Pregnancy (N=17)
	Abnormal blood loss, n (%) Respiratory conditions	11	101 (53)	3.1		83 (100)	7	4 (7) 4.7	6 (35)
	QBL, mean (SD) Cardiac conditions Renal conditions	17 48	3,360.1 (2,131.9) 13.4 4.7		3,587.6 (2,155.7)	14 16	1,816.8 (1,180.3) 9.3 10.7	4,091.5 (2,252.7)
	Sepsis Units of blood products transfused, mean (SD) Other obstetric	43 41	12.0 9.4 (6.6) 11.5		9.9 (6.7)	11 23	7.3 4.8 (5.0) 15.3	8.7 (6)
	Units of blood products Other medical transfused, range	22	1-46	6.1	3-46 Pearson X 2	15	1-12 10.0 11.6	4-16
	Massive Transfusion Protocol called, n (%) Notes:	34 (35)		P	33 (41)		0 (0) 0.072	1 (17)
	Notes: QBL, quantitative blood loss in milliliters. QBL and units of blood products transfused missing for 3
	patients with abnormal blood loss.						
	Data source: Maryland SMM Surveillance and Review Database.
Carrie Wolfson, Jiage Qian, Pamela Chin, Cathy Downey, Katie Jo Mattingly, Kimberly Jones-Beatty, Joanne Olaku, Sadaf Qureshi, Jane Rhule, Danielle Silldorff, Robert Atlas, Anne Banfield, Clark T Johnson, Donna Neale, Jeanne S Sheffield, David Silverman, Kacie Mclaughlin, Güneş Koru, Andreea A Creanga
Findings From Severe Maternal Morbidity Surveillance and Review in Maryland