The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina
The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina
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DOI：
10.1111/1471-0528.12395
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发表时间：
2013-12-01
影响因子：
5.8
通讯作者：
Gregoris, C.
中科院分区：
文献类型：
--
作者：
Karolinski, A.;Mercer, R.;Gregoris, C.
目的分析阿根廷公立医院发生的危及生命的产科并发症。设计多中心协作横断面研究。设置布宜诺斯艾利斯都市区围产期网络中纳入的25家医院。人群1年期间在参与医院分娩的妇女。方法对妊娠期（包括流产和人工流产）、临产和产褥期发生严重孕产妇发病率（SMM）和孕产妇死亡率（MM）的所有病例进行分析。包括在内。前瞻性收集数据。主要结局指标SMM的识别标准、主要原因和发生率；病死率、发病率-死亡率指数和有效干预措施的使用率。结果总共确定了 552 名患有危及生命状况的妇女：518 名患有 SMM，34 名患有 MM。 SMM的识别标准是病例管理（48.9%）、器官功能障碍（15.2%）和混合标准（35.9%）。 SMM 的发生率为 0.8%（95% 置信区间 [95% CI] 0.73-0.87%），医院孕产妇死亡率为每 10 万活产 52.3 例（95% CI 35.5-69.1）。 MM的主要原因是流产并发症和产后败血症； SMM的主要原因是产后出血和高血压。总体病死率为 6.2%（95% CI 4.4-8.6）：最高因脓毒症 (14.8%) 和流产并发症 (13.3%)。发病率-死亡率指数为 15:1 (95% CI 7.5-30.8)。预防或治疗 MM 和 SMM 主要原因的已知有效干预措施的使用率为 52.3%（95% CI 46.9-57.7）。结论本研究描述了在拥有综合产科护理的公立医院中发生的危及生命的产科并发症的重要性，以及可能降低 SMM 和 MM 发生率的已知有效干预措施的利用率较低。它还提供了论证需要为 SMM 开发监控系统的论据。
ObjectiveTo analyse life-threatening obstetric complications that occurred in public hospitals in Argentina.DesignMulticentre collaborative cross-sectional study.SettingTwenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area.PopulationWomen giving birth in participating hospitals during a 1-year period.MethodsAll cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively.Main outcome measuresIdentification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate.ResultsA total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7).ConclusionsThis study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM.