Avoidable risk factors in perinatal deaths: A perinatal audit in South Australia
Avoidable risk factors in perinatal deaths: A perinatal audit in South Australia
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DOI：
10.1111/j.1479-828x.2007.00801.x
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发表时间：
2008-02-01
影响因子：
1.7
通讯作者：
Dekker, Gus A.
中科院分区：
文献类型：
--
作者：
De Lange, Titia E.;Budde, Marenne P.;Dekker, Gus A.
目的：分析围产儿死亡的危险因素，重点分析潜在的可避免的危险因素，以及不同护理水平的产科单元之间次优保健因素发生频率的差异。方法：描述2001年至2005年南澳大利亚州608例导致围产儿死亡的孕妇，并与86623例活产孕妇进行比较。结果：270例(44.4%)存在一个或多个可避免的孕产妇危险因素，31例(5.1%)存在与获得保健相关的危险因素，68例(11.2%)与专业保健不足有关。104名妇女(17.1%)未能及时就医：其中85%的孕妇有足够的产前检查次数。围产期死亡的独立孕产妇危险因素有：辅助生殖技术(调整后的优势比(AOR)3.16)、早产(AOR22.05)、产前出血(AOR6.40)、其他/不明原因(AOR2.19)、宫内发育迟缓(AOR3.94)、宫颈功能不全(AOR8.89)、先兆流产(AOR1.89)、既往有高血压(AOR 1.72)、精神障碍(AOR 1.85)和最低限度产前护理(AOR 2.89)。病例中最常见的专业护理缺失是未能对高危妊娠/并发症采取行动或识别高危妊娠/并发症，49例(8.1%)。结论：进一步强调产前护理的重要性和教育妇女识别需要专业评估的体征和症状，可以进一步提高围产儿死亡率。进一步关注如何识别和/或管理高危妊娠，可使产妇护理提供者的教育受益。
Objectives: To analyse risk factors of perinatal death, with an emphasis on potentially avoidable risk factors, and differences in the frequency of suboptimal care factors between maternity units with different levels of care.Methods: Six hundred and eight pregnancies (2001-2005) in South Australia resulting in perinatal death were described and compared to 86 623 live birth pregnancies.Results: Two hundred and seventy cases (44.4%) were found to have one or more avoidable maternal risk factors, 31 cases (5.1%) had a risk factor relating access to care, while 68 cases (11.2%) were associated with deficiencies in professional care. One hundred and four women (17.1% of cases) presented too late for timely medical care: 85% of these did have a sufficient number of antenatal visits.The following independent maternal risk factors for perinatal death were found: assisted reproductive technology (adjusted odds ratio (AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage (APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19), intrauterine growth restriction (AOR 3.94), cervical incompetence (AOR 8.89), threatened miscarriage (AOR 1.89), pre-existing hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and minimal antenatal care (AOR 2.89). The most commonly found professional care deficiency in cases was the failure to act on or recognise high-risk pregnancies/complications, found in 49 cases (8.1%).Conclusion: Further improvements in perinatal mortality may be achieved by greater emphasis on the importance of antenatal care and educating women to recognise signs and symptoms that require professional assessment. Education of maternity care providers may benefit from a further focus on how to recognise and/or manage high-risk pregnancies.