Table 2.
Severe maternal morbidity (SMM) types, subtypes, and International Classification of Diseases (ICD‐10CA) and Canadian Classification of Health Interventions (CCI) codes for each SMM subtype
| SMM type | SMM subtype | ICD‐10CA, CCI codes, and other variables |
|---|---|---|
| SPE, HELLP, eclampsia | Severe pre‐eclampsia, HELLP syndrome | O14.1, O14.2 |
| Eclampsia | O15 | |
| Severe haemorrhage | Placenta praevia with haemorrhage and red cell transfusion | O44.1 + RBCTRNSF = ‘Y’ |
| Placental abruption with coagulation defect | O45.0 | |
| Antepartum haemorrhage with coagulation defect | O46.0 | |
| Intrapartum haemorrhage with coagulation defect | O67.0 | |
| Intrapartum haemorrhage with red cell transfusion | O67 + RBCTRNSF = ‘Y’ | |
| Postpartum haemorrhage with red cell transfusion, procedures to the uterus, or hysterectomy |
O72 + any of the following:
|
|
| Curettage with red cell transfusion | (5.PC.91.GA, 5.PC.91.GC, or 5.PC.91.GD) + RBCTRNSF = ‘Y’ | |
| Maternal ICU admission | Maternal ICU admission | FTSPCU in (‘10’,‘20’,‘25’,‘30’,‘35’,‘40’,‘45’,‘60’,‘80’) |
| Surgical complications | Complications of obstetric surgery and procedures | O75.4 |
| Evacuation of incisional haematoma with RBC transfusion | 5.PC.73.JS + RBCTRNSF = ‘Y’ | |
| Repair of bladder, urethra, or intestine | 5.PC.80.JR, 1.NK.80, or 1.NM.80 | |
| Reclosure of caesarean wound with RBC transfusion | (5.PC.80.JM or 5.PC.80.JH) + RBCTRNSF = ‘Y’ | |
| Hysterectomy | Caesarean hysterectomy | 5.MD.60.RC, 5.MD.60.RD, 5.MD.60.KE, 5.MD.60.CB |
| Hysterectomy using an open approach (without bladder neck suspension, suspension of vaginal vault, or pelvic floor repair) | 1.RM.89.LA* (exclude if 1.PL.74, 1.RS.74, or 1.RS.80 code also present) or 1.RM.87.LA‐GX | |
| Sepsis | Puerperal sepsis | O85 |
| Septicaemia during labour | O75.3 | |
| Embolism, shock, DIC | Obstetric shock | O75.1, R57, T80.5, or T88.6 |
| Obstetric embolism | O88 | |
| Disseminated intravascular coagulation | D65 | |
| Assisted ventilation | Assisted ventilation through endotracheal tube | 1.GZ.31.CA‐ND |
| Assisted ventilation through tracheostomy | 1.GZ.31.CR‐ND | |
| Cardiac complications of anaesthesia | O74.2, O89.1 | |
| Cardiac conditions | Cardiac complications of anaesthesia | O74.2, O89.1 |
| Cardiomyopathy | O90.3, I42, I43 | |
| Cardiac arrest and resuscitation | I46, I49.0, 1.HZ.09, 1.HZ.30 | |
| Myocardial infarction | I21, I22 | |
| Pulmonary oedema and heart failure | I50, J81 | |
| Acute renal failure | Acute renal failure | O90.4, N17, N19 or N99.0 |
| Dialysis | 1.PZ.21 | |
| Severe uterine rupture | Rupture of the uterus with red cell transfusion, procedures to the uterus, or hysterectomy | (O71.0 or O71.1) + any of the following:
|
| Cerebrovascular accidents | Cerebral venous thrombosis in pregnancy | O22.5 |
| Cerebral venous thrombosis in the puerperium | O87.3 | |
| Subarachnoid and intracranial haemorrhage, and cerebral infarction | I60, I61, I62, I63, or I64 | |
| Acute fatty liver with red cell transfusion or plasma transfusion | O26.6 + (RBCTRNSF=‘Y’ or PLSTRNSF=’Y’) | |
| Hepatic failure | K71 or K72 | |
| Cerebral oedema or coma | G93.6 or R40.2 | |
| Other types | Pulmonary, cardiac, and CNS complications of anaesthesia during pregnancy, labour, delivery, or the puerperium | O29.0, O29.1, O29.2, O89.0, O89.1, O89.2, O74.0, O74.1, O74.2, or O74.3 |
| Status asthmaticus | J45.01, J45.11, J45.81, or J45.91 | |
| Adult respiratory distress syndrome | J80 | |
| Acute abdomen | K35, K37, K65, N73.3, or N73.5 | |
| Surgical or manual correction of inverted uterus for vaginal births only | 5.PC.91.HQ or 5.PC.91.HP, restricted to vaginal births (ie absence of caesarean code 5.MD.60) | |
| Sickle cell anaemia with crisis | D57.0 | |
| Acute psychosis | F53.1 or F23 | |
| Status epilepticus | G41 | |
| HIV disease | B20‐24, O98.7 | |
on selected diagnostic and procedure codes:
• Canadian Institute for Health Information coding specific to severe pre‐eclampsia and HELLP (O14.1 and O14.2) began in 2012. The conditions under acute fatty liver (O26.6) were expanded in ICD‐10‐CA version 2009, to add codes for the sixth digits of ‘2’ (Delivered, with mention of postpartum complication) and ‘4’ (Postpartum condition or complication). Previously postpartum liver disorders may have been captured at O90.802 and O90.804 Other complications of the puerperium, not elsewhere classified, respectively. In addition, in ICD‐10‐CA version 2009 the conditions included in this code were expanded to include ‘Cholestasis (intrahepatic) in pregnancy’ and ‘Obstetric cholestasis’. Previously, cholestasis in pregnancy would have been classified as O99.6 Diseases of the digestive system complicating pregnancy, childbirth and the puerperium which included conditions in K80‐K93, and more specifically, K83.1 Cholestasis NEC.
• The CCI code 5.PC.91.HV Interventions to uterus (following delivery or abortion), compression using intrauterine balloon was introduced in CCI version 2012. Previously, this intervention may have been captured by code 5.PC.91.HT Interventions to uterus (following delivery or abortion) uterine (and vaginal) packing.
1.RM.89.LA is included only if codes 1.PL.74, 1.RS.74, or 1.RS.80 are NOT also present.