Samuelsson Eva, Hellgren Margareta, Högberg Ulf
Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Acta Obstet Gynecol Scand. 2007;86(4):435-43. doi: 10.1080/00016340701207500.
The objective of this study was to report deaths from amniotic fluid embolism (AFE) and pregnancy-related venous thromboembolism (VTE), to study contributing factors, and to analyse mortality trends.
Using the Swedish Cause of Death Register (CDR), we identified all women aged 15-44, who died during 1990-1999, with VTE or AFE coded as the underlying or contributory cause of death. We scrutinised medical records, and women who had died during pregnancy or within 6 weeks of terminated pregnancy were included. We also used data from the Medical Birth Register (MBR) on incident and fatal cases. Mortality data from the 1970s and 1980s were based on previous studies, in which cases were identified through register linkage (CDR and MBR).
Five women died of AFE and 10 of VTE - 6 in early pregnancy - during the 1990 s. Five of the cases were not registered as maternal deaths. Only 4 cases were reported as pregnancy-related deaths from pulmonary embolism (PE). Cesarean section/surgery without thromboprophylaxis, overweight, severe intercurrent disease, delays in seeking health care, and verbal miscommunication were contributing factors in the VTE cases. VTE mortality rates (pregnancy >28 weeks and/or a registered birth) were 1.0 (0.5-1.8), 0.8 (0.3-1.6), and 0.4 (0.1-1.0) per 100,000 live births during the 1970s, 1980s and 1990 s, respectively; the corresponding respective figures for AFE were 1.0 (0.5-1.8), 1.1 (0.6-2.1), and 0.5 (0.2-1.1) per 100,000 live births. The case fatality rate for VTE decreased from 4.5% in the 1970s, to 0.6% in the 1990 s, paralleled with quadrupled incidence. The case fatality rate for AFE was unaltered and high, around 45%, during those 3 decades.
Mortality from pregnancy-related PE in Sweden is in the lowest range ever reported, and shows a downward trend during the 1990 s, with a shift towards early pregnancy. In order to monitor mortality trends, death certificate quality must improve, and registers must be linked routinely.
本研究的目的是报告羊水栓塞（AFE）和妊娠相关静脉血栓栓塞（VTE）导致的死亡情况，研究相关影响因素，并分析死亡率趋势。
利用瑞典死亡原因登记册（CDR），我们确定了所有年龄在15 - 44岁之间、在1990 - 1999年期间死亡、且VTE或AFE被编码为根本或促成死亡原因的女性。我们仔细审查了医疗记录，并纳入了在孕期或终止妊娠后6周内死亡的女性。我们还使用了医疗出生登记册（MBR）中关于发病和死亡病例的数据。20世纪70年代和80年代的死亡率数据基于先前的研究，在这些研究中，通过登记册关联（CDR和MBR）确定病例。
在20世纪90年代，有5名女性死于AFE，10名死于VTE - 其中6例发生在孕早期。有5例未被登记为孕产妇死亡。只有4例被报告为与妊娠相关的肺栓塞（PE）死亡。剖宫产/手术时未进行血栓预防、超重、严重的并发疾病、就医延迟以及言语沟通不畅是VTE病例的影响因素。20世纪70年代、80年代和90年代，VTE死亡率（孕周>28周和/或有登记出生）分别为每10万活产1.0（0.5 - 1.8）、0.8（0.3 - 1.6）和0.4（0.1 - 1.0）；AFE的相应数字分别为每10万活产1.0（0.5 - 1.8）、1.1（0.6 - 2.1）和0.5（0.2 - 1.1）。VTE的病死率从20世纪70年代的4.5%降至90年代的0.6%，同时发病率增加了四倍。在这三十年中，AFE的病死率没有变化且一直很高，约为45%。
瑞典与妊娠相关的PE死亡率处于有史以来报道的最低水平，且在20世纪90年代呈下降趋势，且有向孕早期转移的趋势。为了监测死亡率趋势，必须提高死亡证明的质量，并定期进行登记册关联。
