Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Anesthesiology. 2011 Nov;115(5):963-72. doi: 10.1097/ALN.0b013e318233042d.
Maternal morbidity and mortality are increased in the United States compared with that of other developed countries. The objective of this investigation is to determine the extent to which it is possible to predict which patients will experience near-miss morbidity or mortality.
The authors defined near-miss morbidity as end-organ injury associated with length of stay greater than the 99 percentile or discharge to a second medical facility, and identified all cases of near-miss morbidity or death from admissions for delivery in the 2003-2006 Nationwide Inpatient Sample. Logistic regression was used to examine the effect of maternal characteristics on rates of near-miss morbidity/mortality.
Approximately 1.3 per 1,000 hospitalizations for delivery was complicated by near-miss morbidity/mortality as defined in this study (95% CI 1.3-1.4). Most of these events (58.3%) occurred in 11.8% of the delivering population-in those women with important medical comorbidities or obstetric complications identified before admission for delivery. The highest rates were noted among women with pulmonary hypertension (98.0 cases per 1,000 deliveries), malignancy (23.4 per 1,000), and systemic lupus erythematosus (21.1 per 1,000).
Risk for near-miss morbidity or mortality is substantially increased among an identifiable subset of pregnant women. To the extent that antepartum multidisciplinary coordination and high-quality intrapartum care improve delivery outcomes for women with significant antepartum medical and obstetric disease, then public health investments to reduce the national burden of delivery-related near-miss morbidity and mortality will have the greatest effect by focusing resources on identifying and serving these high-risk groups.
与其他发达国家相比，美国的产妇发病率和死亡率较高。本研究的目的是确定在多大程度上可以预测哪些患者会出现接近发病的发病率或死亡率。
作者将接近发病的发病率定义为与住院时间超过第 99 百分位或转至第二家医疗机构相关的终末器官损伤，并确定了 2003-2006 年全国住院患者样本中所有因分娩而入院的接近发病的发病率或死亡病例。使用逻辑回归检查产妇特征对接近发病的发病率/死亡率的影响。
在本研究中，大约每 1000 例分娩住院中有 1.3 例（95%CI 1.3-1.4）出现接近发病的发病率/死亡率。这些事件中的大多数（58.3%）发生在 11.8%的分娩人群中-在入院前就有重要的合并症或产科并发症的女性中。在患有肺动脉高压的女性中发病率最高（每 1000 例分娩中有 98.0 例），恶性肿瘤（每 1000 例分娩中有 23.4 例）和系统性红斑狼疮（每 1000 例分娩中有 21.1 例）。
在可识别的孕妇亚组中，接近发病的发病率或死亡率大大增加。在一定程度上，产前多学科协调和高质量的分娩护理可以改善患有严重产前医学和产科疾病的女性的分娩结局，因此，通过集中资源识别和服务这些高风险人群，公共卫生投资将对减少与分娩相关的接近发病的发病率和死亡率的国家负担产生最大影响。
