Virginia Department of Health, Office of the Chief Medical Examiner, Richmond, Virginia 23219, USA.
J Womens Health (Larchmt). 2009 Jul;18(7):1041-8. doi: 10.1089/jwh.2008.1037.
To determine if substance abuse, mental illness, and domestic violence contributed to preventable pregnancy-associated death and to describe characteristics of women for whom these factors contributed to death.
The medical records of 121 women who had pregnancy-associated deaths in Virginia between 1999 and 2001 were reviewed. The incidence of substance abuse, mental illness, and domestic violence was noted during systematic review. Multidisciplinary review of cases was conducted to determine if these factors contributed to death and if reasonable changes may have prevented death.
The pregnancy-associated maternal mortality ratio for women experiencing substance abuse, mental illness, or domestic violence as contributors to death was 17.1. Thus, for every 100,000 live births in Virginia, 17.1 women had at least one of these factors directly contribute to death. Substance abuse contributed to death in 28.9% of all cases reviewed (pregnancy-associated maternal mortality ratio = 12.2); 45.7% of those deaths were considered preventable. Mental illness contributed to death in 16.5% of cases (pregnancy-associated maternal mortality ratio = 6.9), with 50.0% considered preventable. Domestic violence contributed to death in 14.0% of cases (pregnancy-associated maternal mortality ratio = 5.9), with 64.7% of cases considered preventable. Median household incomes and years of education completed varied widely. Pregnancy-associated maternal mortality ratios for each factor were higher among African American women than among white women.
Psychosocial risk assessment with appropriate referral should be completed for all women seeking care regardless of social status, education, or race.
确定药物滥用、精神疾病和家庭暴力是否导致可预防的妊娠相关死亡，并描述这些因素导致死亡的妇女的特征。
对 1999 年至 2001 年间弗吉尼亚州 121 名妊娠相关死亡妇女的病历进行了回顾。在系统评价中注意到药物滥用、精神疾病和家庭暴力的发生率。对病例进行多学科审查，以确定这些因素是否导致死亡，以及是否可以进行合理的改变以防止死亡。
在经历药物滥用、精神疾病或家庭暴力作为死亡原因的妇女中，妊娠相关孕产妇死亡率为 17.1。因此，在弗吉尼亚州每 10 万例活产中，有 17.1 名妇女至少有一种这些因素直接导致死亡。在所有审查的病例中，药物滥用导致死亡的比例为 28.9%（妊娠相关孕产妇死亡率=12.2）；其中 45.7%的死亡被认为是可以预防的。精神疾病导致死亡的比例为 16.5%（妊娠相关孕产妇死亡率=6.9），其中 50.0%被认为是可以预防的。家庭暴力导致死亡的比例为 14.0%（妊娠相关孕产妇死亡率=5.9），其中 64.7%的病例被认为是可以预防的。家庭收入中位数和完成的受教育年限差异很大。每个因素的妊娠相关孕产妇死亡率在非裔美国妇女中均高于白人妇女。
无论社会地位、教育程度或种族如何，所有寻求护理的妇女都应进行社会心理风险评估，并进行适当的转介。
