How do the indicators used by a city or metropolitan region differ from the global indicators12/14/2023 ![]() SMM was associated with maternal age, socioeconomic status, and adverse obstetric factors using various international SMM indicators. Additionally, inadequate prenatal care was associated with a 1.1- to 1.4-fold higher risk of SMM compared to adequate prenatal care. In residential area, women who lived in rural area had approximately 1.2- to 1.5-fold higher risk of SMM compared to those who lived in Seoul. In sub indicators, hemorrhage-related codes constituted the highest proportion of all SMM indicators. The SMM incidence rates in 6,421,091 deliveries, were 2.36%, 3.12%, 0.31%, and 1.36% using the US-CDC, ACOG, Zwart et al.’s, and EURONET SAMM indicators, respectively. Generalized estimating equations models were used to identify the relationships between SMM indicators and risk factors. SMM was estimated using four indicators: the United States Centers for Disease Control and Prevention (US-CDC) SMM algorithm, the American College of Obstetricians and Gynecologists (ACOG) gold standard guidelines, Zwart et al.’s indicators for the Netherlands, and the European Network on Severe Acute Maternal Morbidity (EURONET-SAMM) index. This study used the National Health Insurance delivery cohort in South Korea from 2003 to 2018. Therefore, this study aimed to compare the SMM risk assessment using four international indicators and identify the factors underlying the differences among the risk assessments obtained by the various indicators. Even though several severe maternal morbidity (SMM) indicators exist globally, indicators that can serve as international standards are needed.
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