Jayaratnam Skandarupan, De Costa Caroline, Howat Paul
Department of Obstetrics and Gynaecology, Cairns Base Hospital, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2011 Oct;51(5):421-5. doi: 10.1111/j.1479-828X.2011.01330.x. Epub 2011 Jul 5.
Maternal mortality is now a rare event in the developed world and its measurement is no longer a useful way of assessing obstetric care. Examination of cases of women who nearly died but survived a severe complication of pregnancy or childbirth - maternal 'near-misses' - is increasingly being recognised as potentially more useful, although severe maternal morbidity is much less easy to define and quantify than maternal death.
To identify and assess prospectively cases of severe maternal morbidity presenting to Cairns Base Hospital (CBH), to define cases as near-misses and thereby develop a tool for future assessment of obstetric care in CBH and elsewhere.
Based on approaches recommended by the recent WHO working group on Maternal Mortality and Morbidity classifications, a data collection form was constructed using a combination of named morbidities and specific interventions. Over 1 year data from all cases of severe maternal morbidity was collected and analysed both prospectively and retrospectively to identify true near-misses.
Seventeen cases of true near-misses were identified, giving a near-miss rate of six per 1000 live births for CBH in the study period; 64% of cases were attributable to obstetric causes and 36% to non-obstetric causes.
Collection of near-miss data has the potential to become a useful tool for the assessment of obstetric care in both in CBH and in other Australian hospitals but is time-consuming and requires continuous surveillance by medical staff if cases are not to be overlooked.
在发达国家，孕产妇死亡如今已属罕见事件，其衡量指标不再是评估产科护理的有效方式。对那些在妊娠或分娩严重并发症中险些丧命但最终存活下来的产妇病例——即孕产妇“险些死亡”情况——的检查日益被认为可能更具实用性，尽管严重孕产妇发病情况比孕产妇死亡更难定义和量化。
前瞻性地识别和评估凯恩斯基地医院（CBH）出现的严重孕产妇发病病例，将病例定义为险些死亡情况，从而开发一种工具，用于未来对CBH及其他地方产科护理进行评估。
基于世界卫生组织近期孕产妇死亡率和发病率分类工作组推荐的方法，通过结合特定疾病名称和具体干预措施构建了一份数据收集表。收集并前瞻性和回顾性分析了1年多来所有严重孕产妇发病病例的数据，以识别真正的险些死亡情况。
识别出17例真正的险些死亡病例，在研究期间CBH的险些死亡率为每1000例活产中有6例；64%的病例归因于产科原因，36%归因于非产科原因。
收集险些死亡数据有可能成为评估CBH及其他澳大利亚医院产科护理的有用工具，但耗时且若要不遗漏病例需要医务人员持续监测。
