Severe maternal morbidity due to obstetric haemorrhage: Potential preventability
Severe maternal morbidity due to obstetric haemorrhage: Potential preventability
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DOI：
10.1111/ajo.13040
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发表时间：
2019-07-26
影响因子：
1.7
通讯作者：
MacDonald, Evelyn Jane
中科院分区：
文献类型：
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作者：
Lepine, Sam J.;Geller, Stacie E.;MacDonald, Evelyn Jane
背景妊娠期出血可能危及妇女和婴儿的生命。可以通过发现高危妇女、执行指导方针和治疗计划、及早发现血容量不足症和及时给予适当治疗，减少产科大出血的影响。目的描述新西兰产科出血引起的严重孕产妇发病率的情况，并调查这些情况下的潜在可预防性。材料与方法一个多学科的专家审查小组成立，以审查产科出血的情况下，重症监护或高度依赖单位超过18个月的跨度在新西兰。由多学科临床医生组成的小组对病例进行了批判性分析，以确定潜在的可预防性。结果共发现120例产后出血，其中36%（n = 43）的产后出血是可以预防的，主要原因是诊断延误或失败（65%，28/43）和/或治疗失败或延误（91%，39/43）。23%的病例（28/120）导致围产期子宫切除术，其中三分之一被认为是潜在的预防。结论及时识别和治疗，根据循证指南是必要的，以减少产科出血的发病率负担。强调培训临床医生及时发现出血，可以避免不必要的产科急诊，并可以改善产妇和新生儿的结局。
Background Haemorrhage in pregnancy may be life-threatening to woman and infant. The impact of severe obstetric haemorrhage can be reduced by detecting high-risk women, implementing guidelines and treatment plans, early detection of hypovolaemia and timely appropriate treatment. Aims To describe cases of severe maternal morbidity caused by obstetric haemorrhage in New Zealand and investigate the potential preventability of these cases. Materials and Methods A multidisciplinary expert review panel was established to review cases of obstetric haemorrhage admitted to intensive care or high-dependency units over an 18-month span in New Zealand. Cases were critically analysed by a multidisciplinary team of clinicians to determine the potential preventability. Results One hundred and twenty cases were identified, most commonly due to postpartum haemorrhage with 36% (n = 43) deemed potentially preventable, mainly due to delay or failure of diagnosis (65%, 28/43) and/or failure or delay in treatment (91%, 39/43). Twenty-three per cent of cases (28/120) resulted in peripartum hysterectomy of which one-third were deemed potentially preventable. Conclusions Prompt recognition and treatment in accordance with evidence-based guidelines is imperative to decrease the burden of morbidity from obstetric haemorrhage. An emphasis on training clinicians to identify haemorrhage in a timely way may avoid unnecessary obstetric emergencies and can improve maternity and neonatal outcomes.