Department of Obstetrics & Gynaecology, Faculty of Medicine, Damascus University, Damascus, Syria.
BMC Pregnancy Childbirth. 2010 Oct 19;10:65. doi: 10.1186/1471-2393-10-65.
Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.
Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.
There were 28,025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100,000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).
Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.
调查严重产妇发病率（接近发病率）是一种新的工具，它可以确定产妇死亡率最高的妇女，并帮助分配资源，特别是在低收入国家。本研究旨在 i. 在叙利亚大马士革的医院一级记录产妇接近发病率的频率和性质，ii. 通过比较接近发病率和产妇死亡率来评估产妇救生紧急服务的护理水平。
对 2006-2007 年在叙利亚大马士革妇产大学医院发生的接近发病率和产妇死亡率的病例进行回顾性基于设施的审查。接近发病率病例基于特定疾病的标准（Filippi 2005）定义，包括：出血、妊娠高血压疾病、难产、感染和贫血。主要结果包括产妇死亡率（MMR）、产妇接近发病率（MNMR）、死亡率指数以及接近发病率病例和死亡率病例与住院人数的比例。
共有 28025 例分娩，15 例产妇死亡和 901 例接近发病率。研究表明，每 1000 例活产的接近发病率为 32.9/1000，每 100000 例活产的产妇死亡率为 54.8/100000，死亡率指数相对较低，为 1.7%。妊娠高血压疾病（52%）和出血（34%）是接近发病率的主要原因。晚期妊娠出血是产妇死亡的主要原因（60%），而败血症的死亡率指数最高（7.4%）。大多数病例（93%）来自其他医疗机构，即传统助产士家庭（67%）、初级（5%）和二级（10%）医疗机构和私人诊所（11%），病情危急。26%的接近发病率病例被收治重症监护病房（ICU）。
接近发病率分析提供了宝贵的产科护理信息。该研究强调需要改善产前保健，这将有助于早期识别高危妊娠。它还强调了制定预防/管理产后出血的方案和培训医疗保健专业人员以处理不常见但致命的疾病（如败血症）的重要性。强烈建议对叙利亚的转诊系统和紧急产科护理进行紧急审查。
