Severe Obstetric Complications

Patients with severe obstetric complications which occur during the inpatient delivery hospitalization

Measure specifications are in the Public Domain.

LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.

These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Stratum1: Delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication.

Additionally, this measure will be stratified by race and ethnicity after measure submission.

The Severe Obstetric Complications Risk Adjustment Methodology Report is available on the eCQI Resource Center (https://ecqi.healthit.gov).
Pre-existing conditions and variables must be present on admission.  Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data.
-	Anemia
-	Asthma 
-	Autoimmune Disease
-	Bariatric Surgery
-	Bleeding disorder
-	Cardiac Disease
-	Gastrointestinal Disease 
-	Gestational Diabetes
-	HIV
-	Housing Instability
-	Hypertension
-	Maternal Age (derived from birthdate)
-	Mental Health Disorder
-       Morbid Obesity
-	Multiple Pregnancy	
-	Neuromuscular Disease 
-	Other Pre-eclampsia
-	Placenta Previa
-	Placental Abruption
-	Placental Accreta Spectrum
-	Pre-existing Diabetes 
-	Preterm Birth
-	Previous Cesarean 
-	Pulmonary Hypertension
-	Renal Disease 
-	Severe Pre-eclampsia
-	Substance Abuse
-	Thyrotoxicosis 
-	Long-term Anticoagulant Use
-	Obstetric VTE

Lab and Physical Exam Results:
Report the first resulted value 24 hours prior to start of encounter and before time of delivery in UCUM units specified:
-	Heart rate: {beats}/min
-	Systolic blood pressure: mm[Hg]
-	White blood cell count: 10*3/uL 
-       Hematocrit: %

Note regarding submission of risk variable data: The risk variable definitions are included in the specifications and risk variable data should be sent with eCQM data in the QRDA1 file. Specific risk variable templates are not needed in the QRDA1 files.

Hospital-level measure scores are calculated as a risk-adjusted proportion of the number of delivery hospitalizations for women who experience a severe obstetric complication, as defined by the numerator, by the total number of delivery hospitalizations in the denominator during the measurement period. The hospital-level measure score will be reported as a rate per 10,000 delivery hospitalizations.

Stratum 1 is a subset of the numerator population:  
(Number of delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication / (Number of encounters in Denominator - Number of encounters in Denominator Exclusions)) * 10,000

The United States (US) experiences higher rates of maternal morbidity and mortality than most other developed countries. These rates have continued to trend upward in recent decades (CDC, n.d.). Research indicates that the overall rate of severe maternal morbidity (SMM) increased by almost 200% between 1993 and 2014 to 144 per 10,000 delivery hospitalizations (CDC, n.d.), with more than 25,000 women per year experiencing obstetric complications (U.S. Department of Health and Human Services, 2020). Recent maternal mortality data from 2018 reveal that 658 women in the US died from maternal causes, resulting in a rate of 17.4 deaths per 100,000 live births, with 77% of the deaths attributed to direct obstetric causes like hemorrhage, preeclampsia, obstetric embolism, and other complications (Hoyert & Minino, 2018). 144 per 10,000 women hospitalized for delivery have experienced SMM, including hemorrhage, embolism, hypertension, stroke, and other serious complications (CDC,2020). Racial and ethnic disparities for Black women and Hispanic women are at a significantly higher risk for developing these complications than are Non-Hispanic White women (Leonard et al., 2019). Increasing rates of SMM are resulting in increased healthcare costs, longer hospitalization stays and impacts on a woman's health. 

There is limited national evaluation of hospitals' performance on maternal morbidity and mortality although SMM is widely used at the population level. SMM is linked to maternal mortality, varies significantly among hospitals, and has significant racial/ethnic and urban/rural disparities. SMM is a cost driver for both Medicaid and commercial plans. This measure is important as it will assist in the discovery and understanding of SMM patterns which can lead to improvements in the safety and quality of maternal care necessary to reduce SMM rates.

Healthy People 2030 Measure (MICH-05): Reduce severe maternal complications identified during delivery hospitalizations

The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine (SMFM) recommend identifying potential cases of severe maternal morbidity for further review, with a focus on outcomes and complications, and consider this an important step toward promoting safe obstetric care.

Improvement noted as a decrease in the rate

Reference Type: CITATION

Reference Text: 'American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick, S. K., & Ecker, J. L. (2016). Severe maternal morbidity: screening and review. American journal of obstetrics and gynecology, 215(3), B17–B22. https://doi.org/10.1016/j.ajog.2016.07.050'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2021, February 2). Severe maternal morbidity in the United States. Division of Reproductive Health. Retrieved December 14, 2022, from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html'

Reference Type: CITATION

Reference Text: 'Hoyert, D. L., & Minino, A. M. (2020). Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 69(2), 1–18.'

Reference Type: CITATION

Reference Text: 'Leonard, S. A., Kennedy, C. J., Carmichael, S. L., Lyell, D. J., & Main, E. K. (2020). An Expanded Obstetric Comorbidity Scoring System for Predicting Severe Maternal Morbidity. Obstetrics and gynecology, 136(3), 440–449. https://doi.org/10.1097/AOG.0000000000004022'

Reference Type: CITATION

Reference Text: 'Leonard, S. A., Main, E. K., & Carmichael, S. L. (2019). The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC pregnancy and childbirth, 19(1), 16. https://doi.org/10.1186/s12884-018-2169-3'

Reference Type: CITATION

Reference Text: 'Leonard, S. A., Main, E. K., Scott, K. A., Profit, J., & Carmichael, S. L. (2019). Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Annals of epidemiology, 33, 30–36. https://doi.org/10.1016/j.annepidem.2019.02.007'

Reference Type: CITATION

Reference Text: 'Main, E. K., Leonard, S. A., & Menard, M. K. (2020). Association of Maternal Comorbidity With Severe Maternal Morbidity: A Cohort Study of California Mothers Delivering Between 1997 and 2014. Annals of internal medicine, 173(11 Suppl), S11–S18. https://doi.org/10.7326/M19-3253'

Reference Type: CITATION

Reference Text: 'Office of Disease Prevention and Health Promotion (Ed.). (n.d.). Reduce severe maternal complications identified during delivery hospitalizations - mich‑05. Retrieved December 14, 2022, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-severe-maternal-complications-identified-during-delivery-hospitalizations-mich-05'

Reference Type: CITATION

Reference Text: 'U.S. Department of Health and Human Services. (n.d.). The Surgeon General's Call to Action to Improve Maternal Health. Retrieved December 15, 2022, from https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf'

For this measure, specifications are modeled after the nationally available and adopted CDC definition for Severe Maternal Morbidity (SMM) with the addition of maternal mortality. At times, we may refer to the CDC indicators of morbidity as SMM, but the outcome of the measure, which includes morbidity and mortality, is referred to as Severe Obstetric Complications (SOC).

In the case of multiple births, map the first delivery date/time (Baby A) as the delivery date/time for the encounter.

This measure allows for 3 approaches to determine gestational age (GA) in the following order of precedence:

1.  The GA is calculated using the American College of Obstetricians and Gynecologists ReVITALize guidelines.*
2.  The GA is obtained from a discrete field in the electronic health record.  This option is only used when the calculated GA is not available.
3.  The GA is based on ICD10 or SNOMED codes indicative of weeks gestation.  This option is only used when results from items #1 and #2 (see above) are not available.

Wherever gestational age is mentioned, relative to the delivery, the intent is to capture the last estimated gestational age prior to or at the time of delivery.  
 
*ACOG ReVITALize Guidelines for Calculating Gestational Age:      
     
                                Gestational Age = (280-(Estimated Due Date minus Reference Date))/7

--Estimated Due Date (EDD): The best obstetrical EDD is determined by last menstrual period if confirmed by early ultrasound or no ultrasound performed, or early ultrasound if no known last menstrual period or the ultrasound is not consistent with last menstrual period, or known date of fertilization (e.g., assisted reproductive technology) 
--Reference Date is the date on which you are trying to determine gestational age. For purposes of this eCQM, Reference Date would be the Date of Delivery.   

Note however the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Inpatient hospitalizations for patients age >= 8 years and < 65 admitted to the hospital for inpatient acute care who undergo a delivery procedure with a discharge date that ends during the measurement period

Inpatient hospitalizations for patients delivering stillborn or live birth with >= 20 weeks, 0 days gestation completed

Inpatient hospitalizations for patients with confirmed diagnosis of COVID with COVID-related respiratory condition or patients with confirmed diagnosis of COVID with COVID-related respiratory procedure

Inpatient hospitalizations for patients with severe obstetric complications (not present on admission that occur during the current delivery encounter) including the following: 
-  Severe maternal morbidity diagnoses (see list below)
-  Severe maternal morbidity procedures (see list below)
-  Discharge disposition of expired
Please note that present on admission codes may be those entered by coding staff, extracted from billing/claims data.

Severe Maternal Morbidity Diagnoses:
-  Cardiac
	          Acute heart failure 
	          Acute myocardial infarction
	          Aortic aneurysm
	          Cardiac arrest/ventricular fibrillation
	          Heart failure/arrest during procedure or surgery
-  Hemorrhage
	          Disseminated intravascular coagulation
	          Shock
-  Renal
                  Acute renal failure
-  Respiratory
	          Adult respiratory distress syndrome
	          Pulmonary edema
-  Sepsis
-  Other OB
	          Air and thrombotic embolism
	          Amniotic fluid embolism
	          Eclampsia
	          Severe anesthesia complications
-  Other Medical
	          Puerperal cerebrovascular disorder
	          Sickle cell disease with crisis


Severe Maternal Morbidity Procedures:
-  Blood transfusion
-  Conversion of cardiac rhythm
-  Hysterectomy
-  Temporary tracheostomy
-  Ventilation

Not applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity, sex and calculated gestational age

Table of Contents

• Population Criteria
• Definitions
• Functions
• Terminology
• Data Criteria (QDM Data Elements)
• Supplemental Data Elements
• Risk Adjustment Variables

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

• SDE Ethnicity

  • • ["Patient Characteristic Ethnicity": "Ethnicity"]

     
• SDE Payer

  • • ["Patient Characteristic Payer": "Payer"]

     
• SDE Race

  • • ["Patient Characteristic Race": "Race"]

     
• SDE Sex

  • • ["Patient Characteristic Sex": "ONC Administrative Sex"]

     
• Variable Calculated Gestational Age

  • • //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 
      PCMaternal."Variable Calculated Gestational Age"

     

Risk Adjustment Variables

• Risk Variable Anemia

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Anemia"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Asthma

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Acute or Persistent Asthma"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Autoimmune Disease

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Autoimmune Disease"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Morbid Obesity

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Morbid or Severe Obesity"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Bariatric Surgery

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Bariatric Surgery"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Bleeding Disorder

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Bleeding Disorder"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Cardiac Disease

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Cardiac Disease"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Economic Housing Instability

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Economic Housing Instability"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Gastrointestinal Disease

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Gastrointestinal Disease"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Gestational Diabetes

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Gestational Diabetes"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable HIV

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "HIV in Pregnancy Childbirth and Puerperium"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Hypertension

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Hypertension"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Lab and Physical Exam Results

  • • {
      // First physical exams:  Report heart rate as {beats}/min, systolic blood pressure as mm[Hg]
        FirstHeartRate: "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Heart rate"]),
        FirstSystolicBloodPressure: "FirstPhysicalExamWithEncounterId"(["Physical Exam, Performed": "Systolic blood pressure"]),
      // First lab tests:  Report hematocrit as %, white blood cell count as 10*3/uL
        FirstHematocritLab: "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "Hematocrit lab test"]),
        FirstWhiteBloodCellCount: "FirstLabTestWithEncounterId"(["Laboratory Test, Performed": "White blood cells count lab test"])
      }

     
• Risk Variable Long Term Anticoagulant Use

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Long Term Anticoagulant Use"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Mental Health Disorder

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Mental Health Disorder"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Multiple Pregnancy

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Multiple Pregnancy"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Neuromuscular

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Neuromuscular Disease"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Obstetrical VTE

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Venous Thromboembolism in Pregnancy"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Other Preeclampsia

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Mild or Moderate Preeclampsia"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Placenta Previa

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Placenta Previa"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Placental Abruption

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Placental Abruption"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Placental Accreta Spectrum

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Placental Accreta Spectrum"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Preexisting Diabetes

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Preexisting Diabetes"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Preterm Birth

  • • //CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age.
      ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
          let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
          EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
          where CGA in Interval[20, 36]
            or ( CGA is null
                and ( EGA >= 20 weeks
                    and EGA <= 36 weeks
                )
            )
      )
        union ( PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
            let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),
            EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )
            where CGA is null
              and EGA is null
              and exists ( DeliveryEncounter.diagnoses EncounterDiagnoses
                  where EncounterDiagnoses.code in "Preterm Birth"
                    and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
              )
        )

     
• Risk Variable Previous Cesarean

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Previous Cesarean"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Pulmonary Hypertension

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Pulmonary Hypertension"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Renal Disease

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Renal Disease"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Severe Preeclampsia

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Severe Preeclampsia"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Substance Abuse

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Substance Abuse"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     
• Risk Variable Thyrotoxicosis

  • • "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation" TwentyWeeksPlusEncounter
        where exists ( TwentyWeeksPlusEncounter.diagnoses EncounterDiagnoses
            where EncounterDiagnoses.code in "Thyrotoxicosis"
              and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission is Yes or Exempt"
        )

     

Perinatal Care Maternal