A Prediction Score for Maternal Mortality in Senegal and Mali
A Prediction Score for Maternal Mortality in Senegal and Mali
复制标题
DOI：
10.1097/aog.0b013e31828b33a4
复制
发表时间：
2013-05-01
影响因子：
7.2
通讯作者：
Fournier, Pierre
中科院分区：
文献类型：
--
作者：
Huchon, Cyrille;Dumont, Alexandre;Fournier, Pierre
目的：为了开发和验证孕产妇死亡率评分，以确定患者在医院死亡的风险在developingcountries.METHODS：我们进行了一项前瞻性的观察性研究，在46个转诊医院在塞内加尔和马里，2007年10月1日开始。在研究的前6个月，使用广义估计方程对纳入的患者进行孕产妇死亡率评分的推导（43，624例分娩中有301例死亡），并在接下来的6个月内对纳入的患者进行了验证（46，328例分娩中有345例死亡）。结果：9项标准与孕产妇死亡独立相关：怀孕期间严重贫血、怀孕期间确诊疟疾、产次超过4次、产前就诊少于3次、从其他保健机构转诊、产前或产后出血、先兆子痫或子痫、子宫破裂和生殖器感染或败血症。孕产妇死亡率评分范围为0 - 100，受试者工作特征曲线下面积为0.89（95%置信区间[CI] 0.87-0.91）。孕产妇死亡的低风险组，基于得分小于10，具有99.9%的阴性预测值（95% CI 99.8-99.9）和0.18的阴性似然比，排除孕产妇死亡的概率为0.13%（95% CI 0.09-0.17）。该评分识别存在院内死亡风险的患者的灵敏度为85.0%（95% CI 80.5-88.8）。评分的有效性产生了87.8%的敏感性（95% CI 83.9-91.1），阴性预测值为99.9%（95% CI 99.8-99.9），孕产妇死亡概率为0.12%（95%CI 0.08-0.17）。结论：孕产妇死亡率评分可以帮助卫生保健专业人员识别需要仔细管理的孕产妇死亡风险患者。
OBJECTIVE: To develop and validate a maternal mortality score to identify patients at risk of in-hospital death in developing countries.METHODS: We performed a prospective observational study in 46 referral hospitals in Senegal and Mali, starting October 1, 2007. Derivation of a maternal mortality score was performed, using generalized estimating equation, on patients included during the first 6 months of the study (301 deaths out of 43,624 deliveries) and validated on patients included during the next 6 months (345 deaths out of 46,328 deliveries).RESULTS: Nine criteria were independently associated with maternal death: severe anemia in pregnancy, malaria diagnosed during pregnancy, parity greater than 4, fewer than three antenatal visits, referral from another health facility, antepartum or postpartum hemorrhage, preeclampsia or eclampsia, uterine rupture, and genital infection or sepsis. The maternal mortality score, ranging from 0 to 100, occupies an area under the receiver operating characteristics curve of 0.89 (95% confidence interval [CI] 0.87-0.91). The low-risk group for maternal mortality, based on a score less than 10, has a negative predictive value of 99.9% (95% CI 99.8-99.9) and a negative likelihood ratio of 0.18, ruling out maternal mortality with a probability of 0.13% (95% CI 0.09-0.17). Sensitivity of the score to identify patients at risk of in-hospital death was 85.0% (95% CI 80.5-88.8). Validation of the score yielded a sensitivity of 87.8% (95% CI 83.9-91.1), a negative predictive value of 99.9% (95% CI 99.8-99.9), and a probability of maternal death of 0.12% (95% CI 0.08-0.17) in the low-risk group.CONCLUSION: The maternal mortality score could help health care professionals to identify patients at risk of maternal mortality who need careful management.