Souza J P, Cecatti J G, Parpinelli M A, Serruya S J, Amaral E
Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil.
BMC Pregnancy Childbirth. 2007 Sep 11;7:20. doi: 10.1186/1471-2393-7-20.
The study of severe maternal morbidity survivors (near miss) may be an alternative or a complement to the study of maternal death events as a health care indicator. However, there is still controversy regarding the criteria for identification of near-miss maternal morbidity. This study aimed to characterize the near miss maternal morbidity according to different sets of criteria.
A descriptive study in a tertiary center including 2,929 women who delivered there between July 2003 and June 2004. Possible cases of near miss were daily screened by checking different sets of criteria proposed elsewhere. The main outcome measures were: rate of near miss and its primary determinant factors, criteria for its identification, total hospital stay, ICU stay, and number and kind of special procedures performed.
There were two maternal deaths and 124 cases of near miss were identified, with 102 of them admitted to the ICU (80.9%). Among the 126 special procedures performed, the most frequent were central venous access, echocardiography and invasive mechanical ventilation. The mean hospital stay was 10.3 (+/- 13.24) days. Hospital stay and the number of special procedures performed were significantly higher when the organ dysfunction based criteria were applied.
The adoption of a two level screening strategy may lead to the development of a consistent severe maternal morbidity surveillance system but further research is needed before worldwide near miss criteria can be assumed.
作为一种医疗保健指标，对严重孕产妇发病幸存者（接近死亡）的研究可能是孕产妇死亡事件研究的一种替代或补充。然而，关于识别接近死亡孕产妇发病的标准仍存在争议。本研究旨在根据不同的标准集对接近死亡孕产妇发病进行特征描述。
在一家三级中心进行的描述性研究，纳入了2003年7月至2004年6月期间在该中心分娩的2929名妇女。通过检查其他地方提出的不同标准集，每天筛查可能的接近死亡病例。主要结局指标包括：接近死亡发生率及其主要决定因素、识别标准、总住院时间、重症监护病房（ICU）住院时间以及所进行的特殊程序的数量和种类。
有2例孕产妇死亡，识别出124例接近死亡病例，其中102例入住ICU（80.9%）。在所进行的126项特殊程序中，最常见的是中心静脉置管、超声心动图和有创机械通气。平均住院时间为10.3（±13.24）天。应用基于器官功能障碍的标准时，住院时间和所进行的特殊程序数量显著更高。
采用两级筛查策略可能会促成一个一致的严重孕产妇发病监测系统的建立，但在全球采用接近死亡标准之前，还需要进一步研究。
