• William M Callaghan, William A Grobman, Sarah J Kilpatrick, Elliott K Main, and Mary DʼAlton.
• Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; the Departments of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Cedars-Sinai Medical Center, Los Angeles, California, and Columbia University College of Physicians and Surgeons, New York, New York; and the California Maternal Quality Care Collaborative, Palo Alto, California.
• Obstet Gynecol. 2014 May 1;123(5):978-81.

AbstractAlthough maternal deaths have been the traditional indicator of maternal health, these events are the "tip of the iceberg" in that there are many women who have significant complications of pregnancy, labor, and delivery. Identifying women who experience severe maternal morbidity and reviewing their care can provide critical information to inform quality improvement in obstetrics. In this commentary, we review methods to identify women who experienced severe complications of pregnancy. We propose a simple validated approach based on transfusion of four or more units of blood products, admission to an intensive care unit, or both as a starting point for identification and review of severe maternal morbidity in health care settings for the purpose of understanding successes and failures in systems of care.

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