Incidence and predictors of severe obstetric morbidity: case-control study
Incidence and predictors of severe obstetric morbidity: case-control study
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DOI：
10.1136/bmj.322.7294.1089
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发表时间：
2001-05-05
影响因子：
105.7
通讯作者：
Wolfe, C
中科院分区：
文献类型：
--
作者：
Waterstone, M;Bewley, S;Wolfe, C
目的探讨重症产科发病率及预测因素。设计通过文献综述建立严重产科发病率的定义，病例对照研究来自一组确定的分娩人群，随机选择4名孕妇作为每个病例的对照。在1997年3月1日至1998年2月28日期间，在东南泰晤士地区的所有19家产科医院和6家邻近医院为该地区的孕妇提供护理。参与者是48865名在这段时间内分娩的妇女。结果588例严重产科并发症，发生率为12.0/1000例（95%可信区间11.2 ~ 13.2）。在研究期间，有5例产妇死亡归因于所研究的条件。每1000次分娩的疾病特异性发病率为：严重出血6.7(6.0 ~ 7.5)，严重先兆子痫3.9(3.3 ~ 4.5)，子痫0.2 (0.1 ~ 0.4)，HELLP（溶血、肝酶升高和低血小板）综合征0.5(0.3 ~ 0.8)，严重败血症0.4(0.2 ~ 0.6)，子宫破裂0.2（0.1 ~ 0.4）。年龄超过34岁、非白种人、既往或当前高血压、产后出血、紧急剖腹产、产前住院、多胎妊娠、社会排斥、产前预约时服用铁或抗抑郁药均与调整后的发病率独立相关。结论严重产科发病率及其与死亡率的关系可能是衡量妊娠结局的更敏感指标。大多数事件与产科出血和严重的先兆子痫有关。剖宫产会使发病风险增加四倍。需要开发和评估预测和降低风险的方法，特别强调出血和先兆子痫的管理。
Objective To estimate the incidence and predictors of severe obstetric morbidity.Design Development of definitions of severe obstetric morbidity by literature review Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case.Setting All 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998.Participants 48 865 women who delivered during the time frame.Results There were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment.Conclusion Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.