Ronsmans C, Scott S, Adisasmita A, Deviany P, Nandiaty F
Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
BJOG. 2009 Jan;116(1):82-90. doi: 10.1111/j.1471-0528.2008.01913.x.
We introduce a new and untested approach for the measurement of life-threatening maternal morbidity in populations where not all women give birth in a health facility. By defining complications at the very extreme end of the severity spectrum, we postulate that its count in hospitals can be used to represent the incidence in the general population.
We counted all cases of life-threatening obstetric morbidity in hospitals and all maternal deaths in the population. Using these data, we describe the incidence of life-threatening morbidity in the total population, examine its variation across geographical areas and investigate its relationship with maternal mortality.
Serang and Pandeglang district in West Java, Indonesia.
All women residing in the two districts.
Cross-sectional study of maternal morbidity and mortality.
Pregnancy-related illness and mortality (PRIAM), consisting of life-threatening maternal morbidity (defined using the concepts of near miss and met need for life-saving surgery) and maternal mortality.
The incidence of maternal mortality and life-threatening complications at the population level was 421 and 1416 per 100,000 births, respectively, resulting in an overall ratio of PRIAM of 1837 per 100,000. The overall incidence of PRIAM was much lower in rural than in urban areas (1529 and 2880 per 100,000, respectively, P < 0.001), and it was lowest in rural Serang (1304 per 100,000).
The approach tested in this study--relying on conditions that are 'absolutely' life-threatening such that their count in hospitals can be used to represent the incidence in the general population--is promising but needs further testing in populations with varied disease epidemiology and access to care. Continued investments in hospital-based audits of life-threatening morbidity may ultimately improve the quality and reliability of information on obstetric complications and facilitate the development of rigorous and standard criteria for the definition of life-threatening morbidity.
我们引入一种全新且未经检验的方法，用于测量并非所有妇女都在医疗机构分娩的人群中危及生命的孕产妇发病率。通过定义严重程度谱最极端情况下的并发症，我们假定其在医院中的计数可用于代表一般人群中的发病率。
我们统计了医院中所有危及生命的产科发病率病例以及该人群中的所有孕产妇死亡病例。利用这些数据，我们描述了总人口中危及生命的发病率，检查其在不同地理区域的差异，并研究其与孕产妇死亡率的关系。
印度尼西亚西爪哇省的西冷和庞岸达兰县。
居住在这两个县的所有妇女。
孕产妇发病率和死亡率的横断面研究。
妊娠相关疾病和死亡率（PRIAM），包括危及生命的孕产妇发病率（使用险些死亡和满足救命手术需求的概念定义）和孕产妇死亡率。
人群层面的孕产妇死亡率和危及生命并发症的发病率分别为每10万例分娩421例和1416例，导致PRIAM的总体比率为每10万例1837例。农村地区PRIAM的总体发病率远低于城市地区（分别为每10万例1529例和2880例，P<0.001），在西冷农村地区最低（每10万例1304例）。
本研究中测试的方法——依赖于“绝对”危及生命的情况，以便其在医院中的计数可用于代表一般人群中的发病率——很有前景，但需要在疾病流行病学和获得医疗服务情况各异的人群中进一步测试。持续投资于基于医院的危及生命发病率审计，最终可能会提高产科并发症信息的质量和可靠性，并有助于制定严格和标准的危及生命发病率定义标准。
