Frequency of and Factors Associated With Severe Maternal Morbidity
Frequency of and Factors Associated With Severe Maternal Morbidity
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DOI：
10.1097/aog.0000000000000173
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发表时间：
2014-04-01
影响因子：
7.2
通讯作者：
Van Dorsten, J. Peter
中科院分区：
文献类型：
--
作者：
Grobman, William A.;Bailit, Jennifer L.;Van Dorsten, J. Peter
目的：估计严重的孕产妇发病率的频率，评估其潜在的病因，并制定一个评分系统，以预测其occurrence.METHODS：这是一个二次分析的尤尼斯肯尼迪施莱佛国家儿童健康和人类发展研究所母胎医学单位网络队列的115,502名妇女和他们的新生儿出生在25家医院在美国超过3年的时间。根据评分系统，考虑到红细胞输注（超过3个单位），插管，意外手术干预，器官衰竭和重症监护病房入院的发生，女性被归类为具有严重的孕产妇发病率。严重的孕产妇发病率的频率进行了计算，并确定了潜在的病因。多变量分析确定了入院时存在的患者因素，这些因素与严重的孕产妇发病率独立相关;这些因素被用来开发一个预测模型为严重的孕产妇发病率。结果：在115,502名妇女谁在研究期间交付，332（2.9/1000出生，95%置信区间2.6-3.2）经历了严重的孕产妇发病率。产后出血约占严重产妇发病率的一半。多个患者因素与重度孕产妇发病率独立相关，并用于建立一个预测模型，其受试者工作特征曲线下面积为0.80。结论：重度孕产妇发病率约为2.9/1000，最常见的原因是产后出血，并且更常见地与几个可识别的患者特征相关。
OBJECTIVE: To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.METHODS: This was a secondary analysis of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (more than three units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity; these were used to develop a prediction model for severe maternal morbidity.RESULTS: Among 115,502 women who delivered during the study period, 332 (2.9/1,000 births, 95% confidence interval 2.6-3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver operating characteristic curve of 0.80.CONCLUSION: Severe maternal morbidity occurs in approximately 2.9 per 1,000 births, is most commonly the result of postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics.