Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017
Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017
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DOI：
10.15585/mmwr.mm6818e1
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发表时间：
2019-05-10
影响因子：
33.9
通讯作者：
Barfield, Wanda
中科院分区：
文献类型：
--
作者：
Petersen, Emily E.;Davis, Nicole L.;Barfield, Wanda
背景资料：方法：分析来自CDC的全国妊娠死亡率监测系统（PMSS）2011-2015年的数据。计算总体和社会人口学特征的妊娠相关死亡率（每10万活产的妊娠相关死亡; PRMR）。按相对于妊娠结束的时间和主要死亡原因计算妊娠相关死亡的分布。分析了13个州孕产妇死亡率审查委员会（MMRC）在2013-2017年期间与妊娠相关的死亡的详细数据，以了解可预防性，导致妊娠相关死亡的因素。结果：2011-2015年，全国PRMR为每10万例活产17.2例。非西班牙裔黑人（黑人）妇女和美洲印第安人/阿拉斯加土著妇女的PRMR最高（分别为42.8和32.5），分别是非西班牙裔白色（白色）妇女PRMR（13.0）的3.3和2.5倍。87.7%（2，990人）的妊娠相关死亡的死亡时间已知。在这些死亡中，31.3%发生在怀孕期间，16.9%发生在分娩当天，18.6%发生在产后1-6天，21.4%发生在产后7-42天，11.7%发生在产后43-365天。死亡的主要原因包括心血管疾病、感染和出血，并因时间而异。来自州MM RC的约60%的妊娠相关死亡被确定为可预防的，并且在人种/种族或死亡时间方面没有显著差异。缅甸红十字会的数据表明，多种因素促成了与怀孕有关的死亡。影响因素和预防策略可按社区、卫生机构、患者、提供者分类。和系统层面，包括改善获得，协调和交付，优质care.Conclusions：妊娠相关死亡发生在怀孕期间，分娩的时间，并长达1年产后，死亡的时间不同的主要原因。大约五分之三的妊娠相关死亡是preventable.Implications公共卫生实践：战略，以解决妊娠相关死亡的促成因素，他可以在社区，卫生设施，病人，供应商和系统层面颁布。
Background: Approximately 700 women die from pregnancy-related complications in the United States every year.Methods: Data from CDC's national Pregnancy Mortality Surveillance System (PMSS) for 2011-2015 were analyze Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births; PRMRs) were calculated overall and by sociodemographic characteristics. The distribution of pregnancy-related deaths by timing relative to the end of pregnancy and leading causes of death were calculated. Detailed data on pregnancy-related deaths during 2013-2017 from 13 state maternal mortality review committees (MMRCs) were analyzed for preventability, factors that contributed to pregnancy-related deaths., and MMRC-identified prevention strategies to address contributing factors.Results: For 2011-2015, the national PRMR was 17.2 per 100,000 live births. Non-Hispanic black (black) women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white (white) women (13.0). Timing of death was known for 87.7% (2,990) of pregnancy-related deaths. Among these deaths, 31.3% occurred during pregnancy, 16.9% on the day of delivery, 18.6% 1-6 days postpartum, 21.4% 7-42 days postpartum, and 11.7% 43-365 days postpartum. Leading causes of death included cardiovascular conditions, infection, and hemorrhage, and varied by timing. Approximately sixty percent of pregnancy-related deaths from state MM RCs were determined to he preventable and did not differ significantly by race/ethnicity or timing of death. MMRC data indicated that multiple factors contributed to pregnancy-related deaths. Contributing factors and prevention strategies can he categorized at the community, health facility, patient, provider., and system levels and include improving access to, and coordination and delivery of, quality care.Conclusions: Pregnancy-related deaths occurred during pregnancy, around the time of delivery, and up to 1 year postpartum; leading causes varied by timing of death. Approximately three in five pregnancy-related deaths were preventable.Implications for Public Health Practice: Strategics to address contributing factors to pregnancy-related deaths can he enacted at the community, health facility, patient, provider, and system levels.