Background
The incidence of severe acute maternal morbidity (SAMM) is one method of measuring the complexity of maternal health and monitoring maternal outcomes. Monitoring trends may provide a quantitative method for assessing health care at local, regional, or jurisdictional levels and identify issues for further investigation.

Aims
Identify temporal trends for SAMM event rates and maternal outcomes over 17 years in the state of Victoria, Australia.

Materials and Methods
All maternal public health service admissions were extracted from an administrative dataset from July 2000 to June 2017. SAMM‐related diagnoses were defined by matching as closely as possible with published definitions. Outcomes included annual SAMM event rates, hospital survival, and hospital length of stay (LOS). Temporal trends were analysed using mixed‐effects generalised linear models.

Results
There were 854 777 live births and 1.21 million pregnancy‐related hospital admissions which included 34 008 SAMM events in 29 273 records and in 3.42% (95%CI = 3.39–3.46) of births. Most common were severe pre‐eclampsia (0.87% of births), severe postpartum haemorrhage (0.59%), and sepsis (0.62%). SAMM‐related admissions were associated with longer LOS and higher mortality risk (P < 0.001). Maternal mortality ratio remained unchanged at 8.6 fatalities per 100 000 births (P = 0.65). Conclusion Over 17 years, there was a significant increase in birth rate and SAMM‐related events in Victoria. Administrative data may provide a pragmatic approach for monitoring SAMM‐related events in maternal health services.