Severe obstetric morbidity in the United States: 1998-2005.
Severe obstetric morbidity in the United States: 1998-2005.
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DOI：
10.1097/aog.0b013e3181954e5b
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发表时间：
2009-02
影响因子：
7.2
通讯作者：
Posner SF
中科院分区：
文献类型：
--
作者：
Kuklina EV;Meikle SF;Jamieson DJ;Whiteman MK;Barfield WD;Hillis SD;Posner SF
研究严重产科并发症发生率的趋势，以及分娩方式和产妇特征的变化对这些趋势的潜在影响。
我们对医疗保健成本和利用项目1998 - 2005年全国住院患者样本中确定的严重产科并发症进行了一项横断面研究。采用逻辑回归分析分娩方式和产妇特征的变化对严重产科并发症发生率的影响。
伴有至少一种严重产科并发症的分娩住院患病率从1998 - 1999年的0.64%（n = 48645）增加到2004 - 2005年的0.81%（n = 68433）。在研究期间，每1000例中显著增加的并发症发生率包括：肾衰竭增加21%（从0.23到0.28），肺栓塞增加52%（从0.12到0.18），成人呼吸窘迫综合征增加26%（从0.36到0.45），休克增加24%（从0.15到0.19），输血增加92%（从2.38到4.58），通气增加21%（从0.47到0.57）。在逻辑回归模型中，对产妇年龄进行调整对2004 - 2005年相对于1998 - 1999年这些并发症风险的增加没有影响。然而，在对分娩方式进行调整后，2004 - 2005年相对于1998 - 1999年这些并发症风险的增加不再显著，但肺栓塞（比值比 = 1.30）和输血（比值比 = 1.72）除外。对支付方、多胎妊娠和某些合并症进一步调整影响不大。
从1998 - 1999年到2004 - 2005年，严重产科并发症的发生率有所增加。对于许多此类并发症，这些增加与剖宫产率的上升有关。
To examine trends in the rates of severe obstetric complications and the potential contribution of changes in delivery mode and maternal characteristics to these trends. We performed a cross-sectional study of severe obstetric complications identified from the 1998–2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Logistic regression was used to examine the effect of changes in delivery mode and maternal characteristics on rates of severe obstetric complications. The prevalence of delivery hospitalizations complicated by at least of one severe obstetric complications increased from 0.64% (n=48,645) in 1998–99 to 0.81% (n=68,433) in 2004–05. Rates of complications per 1,000 which increased significantly during the study period included renal failure by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57). In logistic regression models, adjustment for maternal age had no effect on the increased risk for these complications in 2004–05 relative to 1998–99. However, after adjustment for mode of delivery, the increased risks for these complications in 2004–05 relative to 1998–99 were no longer significant, with the exception of pulmonary embolism (OR=1.30) and blood transfusion (OR=1.72). Further adjustment for payer, multiple births, and select comorbidites had little effect. Rates of severe obstetric complications increased from 1998–99 to 2004–05. For many of these complications, these increases were associated with the increasing rate of cesarean delivery.