Severe Maternal Morbidity in Twins.
Severe Maternal Morbidity in Twins.
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双胞胎中严重的孕产妇发病率。
DOI：
10.1055/a-1974-4449
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发表时间：
2023
影响因子：
2
通讯作者：
Himes,KatherineP
中科院分区：
文献类型：
--
作者：
Binstock,Anna;Bodnar,LisaM;Himes,KatherineP
目的虽然双胎妊娠发生严重孕产妇发病（SMM）的风险增加，但关于双胞胎发生重度孕产妇发病的时间和原因的信息有限。此外，现有数据依赖于SMM的筛选定义，因为金标准方法需要图表审查。我们试图确定双胞胎SMM的时间和原因，使用美国妇产科学院（ACOG）概述的黄金标准定义。研究设计我们使用围产期数据库来识别1998年至2013年在单一学术医疗中心分娩的所有双胞胎（n= 2367）。如果分娩符合以下任何标准，则将其归类为SMM筛查阳性：(1)疾病控制和预防中心（CDC）国际疾病分类第九版SMM诊断和程序代码之一；(2)产后住院时间延长（按分娩方式比平均住院时间超出3个标准差）；或(3)产妇重症监护病房入院。我们使用ACOG产科护理共识中概述的SMM定义，通过对所有筛查阳性分娩的病历审查，确定了SMM的真实病例。我们还确定了SMM的原因和时间。结果165例（7%）双胎分娩SMM筛查阳性。在对所有筛检阳性病例进行图表回顾后，根据ACOG定义，2.4% （n= 56）被归类为真正的SMM病例，阳性预测值为34%。大多数SMM发生在产后（65%）。出血是SMM最常见的病因，其次是高血压和肺部病因。结论常用的SMM筛查方法在双胞胎中效果不佳。这对质量倡议和依赖于产妇发病率筛查定义的流行病学研究具有重要意义。我们的研究表明，产后初期是双胎妊娠妇女产妇健康的关键时期。要点
ObjectiveWhile twin gestations are at increased risk of severe maternal morbidity (SMM), there is limited information about timing and causes of SMM in twins. Furthermore, existing data rely on screening definitions of SMM because a gold standard approach requires chart review. We sought to determine the timing and cause of SMM in twins using a gold standard definition outlined by the American College of Obstetricians and Gynecologists (ACOG).Study DesignWe used a perinatal database to identify all twin deliveries from 1998 to 2013 at a single academic medical center (n= 2,367). Deliveries were classified as screen positive for SMM if they met any of the following criteria: (1) one of the Centers for Disease Control and Prevention (CDC) International Classification of Diseases Ninth Revision diagnosis and procedure codes for SMM; (2) a prolonged postpartum length of stay (>3 standard deviations beyond mean length of stay by mode of delivery); or (3) maternal intensive care unit admission. We identified true cases of SMM through medical record review of all screen-positive deliveries using the definition of SMM outlined in the ACOG Obstetric Care Consensus. We also determined cause and timing of SMM.ResultsA total of 165 (7%) of twin deliveries screened positive for SMM. After chart review of all screen-positive cases, 2.4% (n= 56) were classified as a true case of SMM using the ACOG definition for a positive predictive value of 34%. The majority of SMM occurred postpartum (65%). Hemorrhage was the most common cause of SMM, followed by hypertensive and pulmonary etiologies.ConclusionCommonly used approaches to screen for SMM perform poorly in twins. This has important implications for quality initiatives and epidemiologic studies that rely on screening definitions of maternal morbidity. Our study demonstrates that the immediate postpartum period is a critical time for maternal health among women with twin pregnancies.Key Points