Severe maternal morbidity in Canada, 1991-2001
Severe maternal morbidity in Canada, 1991-2001
复制标题
DOI：
10.1503/cmaj.045156
复制
发表时间：
2005-09-27
影响因子：
14.6
通讯作者：
Kramer, MS
中科院分区：
文献类型：
--
作者：
Wen, SW;Huang, L;Kramer, MS
背景：虽然死亡率经常被用来监测卫生保健的质量，但在工业化国家，孕产妇死亡已变得罕见。因此，建议将严重的产妇死亡率作为监测产妇保健质量的补充指标。我们在这项研究中的目的是描述严重的孕产妇发病率在加拿大超过10年的时间内，妇女有或没有主要的预先存在的conditions.Methods：我们进行了一项回顾性队列研究，涉及2548824名妇女在加拿大医院分娩1991年和2000年之间的严重孕产妇发病率。可能威胁母亲生命的13种情况（E）。例如，在一个实施例中，子痫）和11种主要的预先存在的慢性疾病（例如，例如，在一个实施例中，结果：严重孕产妇发病率为4.38/1000分娩。这些妇女的死亡率是整个样本的158倍。静脉血栓栓塞、子宫破裂、成人呼吸窘迫综合征、肺水肿、心肌梗死、需要子宫切除术的严重产后出血和辅助通气的发生率从1991年到2000年大幅增加。存在的主要预先存在的条件增加了严重的孕产妇发病率的风险，以6倍。解释：严重的孕产妇发病率发生在约1 250交付在加拿大，与显着最近增加某些病态的条件，如肺水肿，心肌梗死，出血需要子宫切除术，并使用辅助通气。
Background: Although death rates are often used to monitor the quality of health care, in industrialized countries maternal deaths have become rare. Severe maternal morbidity has therefore been proposed as a supplementary indicator for surveillance of the quality of maternity care. Our purpose in this study was to describe severe maternal morbidity in Canada over a 10- year period, among women with or without major pre- existing conditions.Methods: We carried out a retrospective cohort study of severe maternal morbidity involving 2 548 824 women who gave birth in Canadian hospitals between 1991 and 2000. Thirteen conditions that may threaten the life of the mother ( e. g., eclampsia) and 11 major pre- existing chronic conditions ( e. g., diabetes) that could be identified from diagnostic codes were noted.Results: The overall rate of severe maternal morbidity was 4.38 per 1000 deliveries. The fatality rate among these women was 158 times that of the entire sample. Rates of venous thromboembolism, uterine rupture, adult respiratory distress syndrome, pulmonary edema, myocardial infarction, severe postpartum hemorrhage requiring hysterectomy, and assisted ventilation increased substantially from 1991 to 2000. The presence of major pre- existing conditions increased the risk of severe maternal morbidity to 6- fold.Interpretation: Severe maternal morbidity occurs in about 1 of 250 deliveries in Canada, with marked recent increases in certain morbid conditions such as pulmonary edema, myocardial infarction, hemorrhage requiring hysterectomy, and the use of assisted ventilation.