Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Bull World Health Organ. 2010 Feb;88(2):113-9. doi: 10.2471/BLT.08.057828. Epub 2009 Sep 11.
To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternal factors and perinatal outcomes.
In a multicenter cross-sectional study, we collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter's association with maternal characteristics and perinatal outcomes.
Of the 97,095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section.
Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.
开发一种孕产妇接近死亡的指标，作为孕产妇死亡的替代指标，并研究其与孕产妇因素和围产儿结局的关系。
在一项多中心横断面研究中，我们从 8 个拉丁美洲国家 120 家医院在两个月至三个月期间分娩的妇女的医院记录中收集了孕产妇和围产儿数据。我们采用分层多阶段整群随机设计。我们评估了院内严重孕产妇发病率的发生情况及其与孕产妇特征和围产儿结局的关系。
在所研究的 97095 名妇女中，有 2964 名（34/1000）因以下一种或多种情况而有更高的死亡风险：入住重症监护病房（ICU）、接受子宫切除术、输血、出现心脏或肾脏并发症或发生子痫。年龄大于 35 岁、没有伴侣、初产妇或产次>3 次以及前次妊娠行剖宫产术是与严重孕产妇发病率发生相关的独立因素。它们还与低出生体重和极低出生体重、死胎、新生儿早期死亡、入住新生儿重症监护病房、产妇产后住院时间延长和剖宫产术的发生率增加呈正相关。
那些从所描述的严重情况中存活下来的妇女可以被视为实用的孕产妇接近死亡病例。降低孕产妇和围产儿死亡率的干预措施应针对这些高风险类别的妇女。
