Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013.
Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013.
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DOI：
10.1371/journal.pone.0157495
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Lozano R
中科院分区：
文献类型：
--
作者：
Lamadrid-Figueroa H;Montoya A;Fritz J;Olvera M;Torres LM;Lozano R
在衡量实现千年发展目标5的进展情况时，采用了一项指标，其中不包括在分娩后42天内因怀孕和分娩而死亡的妇女。这些妇女遭受的死亡被定义为晚期死亡和后遗症相关死亡（根据国际疾病分类第10次修订版，分别为O96和O97）。在计算产妇死亡率（MMR）时，这些死亡最终不会成为分子的一部分，而MMR是政府和国际机构用于报告的指标。这一问题并非微不足道，因为这些死亡占世界所有孕产妇死亡的很大一部分，而且在许多国家呈上升趋势。本研究的目的是分析2010年至2013年墨西哥孕产妇死亡的经验数据，将孕产妇死亡故意搜索和重新分类（BIRMM）和卫生部出生信息子系统（SINAC）的数据库连接起来。资料分析采用负二项回归、生存分析和多因素分析。虽然报告的孕产妇死亡率在2010年至2013年期间每年下降5%，但由于晚期和后遗症相关死亡导致的孕产妇死亡率在2013年翻了一番，从每10万活产3.5例增加到7例（p <0.01）。对所有孕产妇死亡的生存分析显示，除了排除了2013年因分娩而死亡的18%的妇女外，在42天的阈值附近没有任何特别之处。多原因分析显示，排除的死亡和产科原因之间有很强的关联。建议审查孕产妇死亡率的结构，将所有因怀孕和分娩造成的死亡纳入孕产妇死亡定义，使其成为衡量孕产妇死亡率的更具包容性和更有尊严的指标。
Progress towards the Millennium Development Goal No. 5 was measured by an indicator that excluded women who died due to pregnancy and childbirth after 42 days from the date of delivery. These women suffered from what are defined as late deaths and sequelae-related deaths (O96 and O97 respectively, according to the International Classification of Diseases, 10th revision). Such deaths end up not being part of the numerator in the calculation of the Maternal Mortality Ratio (MMR), the indicator that governments and international agencies use for reporting. The issue is not trivial since these deaths account for a sizeable fraction of all maternal deaths in the world and show an upward trend over time in many countries. The aim of this study was to analyze empirical data on maternal deaths that occurred between 2010 and 2013 in Mexico, linking databases of the Deliberate Search and Reclassification of Maternal Deaths (BIRMM) and the Birth Information Subsystem (SINAC) of the Ministry of Health. Data were analyzed by negative binomial regression, survival analysis and multiple cause analysis. While the reported MMR decreased by 5% per year between 2010 and 2013, the MMR due to late and sequelae-related deaths doubled from 3.5 to 7 per 100,000 live-births in 2013 (p <0.01). A survival analysis of all maternal deaths revealed nothing particular around the 42 day threshold, other than the exclusion of 18% of women who died due to childbirth in 2013. The multiple cause analysis showed a strong association between the excluded deaths and obstetric causes. It is suggested to review the construction of the MMR to make it a more inclusive and dignified measurement of maternal mortality by including all deaths due to pregnancy and childbirth into the Maternal Death definition.