Panting-Kemp A, Geller S E, Nguyen T, Simonson L, Nuwayhid B, Castro L
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, 60612, USA.
Am J Obstet Gynecol. 2000 Nov;183(5):1207-12. doi: 10.1067/mob.2000.108846.
The object of this study was to use an in-depth peer-review process to determine the maternal mortality ratio at a single urban perinatal center and to identify factors associated with fatal outcomes to elucidate opportunities for preventive measures to reduce the maternal mortality ratio.
Between 1992 and 1998 all maternal deaths occurring within our perinatal network were identified. A peer-review committee was established to review all available data for each death to determine the underlying cause of death, whether it was related to pregnancy, and whether the death was potentially preventable.
There were 131,500 births and 42 maternal deaths, for a maternal mortality ratio of 31.9 maternal deaths per 100,000 live births. The adjusted pregnancy-related maternal mortality ratio was 22.8 maternal deaths per 100,000 live births, with 37% of those deaths (11/30) deemed potentially preventable and a provider factor cited in >80% of these. Pulmonary embolus and cardiac disease together accounted for 40% of the pregnancy-related deaths.
Local maternal mortality ratios identified through a peer-review process indicate that the magnitude of the problem is much greater than is recognized through national death certificate data. The high proportion of potentially preventable maternal deaths indicates the need for improvement in both patient and provider education if we are to reduce the maternal mortality ratio to 3.3 maternal deaths per 100,000 live births, the stated national health goal of Healthy People 2000.
本研究的目的是通过深入的同行评审过程来确定单个城市围产期中心的孕产妇死亡率，并识别与致命结局相关的因素，以阐明采取预防措施降低孕产妇死亡率的机会。
在1992年至1998年期间，确定了我们围产期网络内发生的所有孕产妇死亡病例。成立了一个同行评审委员会，对每例死亡的所有可用数据进行审查，以确定死亡的根本原因、是否与妊娠相关以及死亡是否有可能预防。
共有131,500例分娩，42例孕产妇死亡，孕产妇死亡率为每10万例活产中有31.9例孕产妇死亡。调整后的与妊娠相关的孕产妇死亡率为每10万例活产中有22.8例孕产妇死亡，其中37%（11/30）的死亡被认为有可能预防，且超过80%的此类死亡病例存在医疗服务提供者因素。肺栓塞和心脏病共占与妊娠相关死亡的40%。
通过同行评审过程确定的当地孕产妇死亡率表明，问题的严重程度远大于通过国家死亡证明数据所认识到的程度。潜在可预防的孕产妇死亡比例很高，这表明如果我们要将孕产妇死亡率降至每10万例活产中有3.3例孕产妇死亡这一《健康人民2000》规定的国家卫生目标，就需要改善患者和医疗服务提供者的教育。
