Lisonkova Sarka, Liu Shiliang, Bartholomew Sharon, Liston Robert M, Joseph K S
Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver BC.
J Obstet Gynaecol Can. 2011 Oct;33(10):1020-30. doi: 10.1016/s1701-2163(16)35051-4.
World Health Organization reports based on Canadian Vital Statistics data suggest a recent increase in maternal mortality rates in Canada. Since Vital Statistics data typically provide inaccurate estimates of maternal mortality, we examined temporal trends in Canada using hospitalization data.
We identified in-hospital deaths among women aged 15 to 54 years from the Canadian Institute for Health Information's hospitalization database from 1996-1997 to 2007-2008. Maternal deaths during delivery were identified, and other in-hospital deaths were linked with prior pregnancy/delivery hospitalization records. Maternal mortality rates, 95% confidence intervals, and risk ratios (RRs) were estimated.
The maternal mortality rate in Canada was 9.2 per 100 000 deliveries (95% CI 7.6 to 11.2) in 1996 to 1999 and 9.0 per 100 000 deliveries (95% CI 7.4 to 10.9) in 2005 to 2007 (P for trend = 0.22). Older maternal age (RR 9.9 and 3.1 for ≥ 45 years and 40 to 44 years vs. 20 to 24 years), delivery by Caesarean section (RR 4.5 vs. vaginal delivery), and early gestation delivery (RR 20.1 and 5.9 for 20 to 27 weeks and 28 to 36 weeks vs. ≥ 37 weeks) were associated with higher maternal mortality. Cardiovascular diseases (rate 4.7 per 100 000 deliveries, 95% CI 3.9 to 5.5) were the most common diagnoses associated with maternal death. The rate of late maternal death (from 43 to 365 days after delivery) was 5.4 per 100 000 deliveries.
There was no increase in maternal mortality in Canada from 1996 to 2007. Increases observed in Canadian Vital Statistics data likely reflect improvements in the ascertainment of maternal death. Hospitalization data can serve as a timely and comprehensive source for monitoring trends in maternal mortality in Canada.
世界卫生组织基于加拿大生命统计数据发布的报告显示，加拿大孕产妇死亡率近期有所上升。由于生命统计数据通常对孕产妇死亡率的估计不准确，我们利用住院数据研究了加拿大的时间趋势。
我们从加拿大卫生信息研究所1996 - 1997年至2007 - 2008年的住院数据库中确定了15至54岁女性的院内死亡情况。确定了分娩期间的孕产妇死亡，并将其他院内死亡与先前的妊娠/分娩住院记录相关联。估计了孕产妇死亡率、95%置信区间和风险比（RRs）。
1996年至1999年加拿大的孕产妇死亡率为每10万例分娩9.2例（95%置信区间7.6至11.2），2005年至2007年为每10万例分娩9.0例（95%置信区间7.4至10.9）（趋势P值 = 0.22）。高龄孕产妇（≥45岁和40至44岁相对于20至24岁的RR分别为9.9和3.1）、剖宫产分娩（RR为4.5相对于阴道分娩）以及早期妊娠分娩（20至27周和28至36周相对于≥37周的RR分别为20.1和。心血管疾病（每10万例分娩发生率为4.7例，95%置信区间3.9至5.5）是与孕产妇死亡相关的最常见诊断。晚期孕产妇死亡（分娩后43至365天）的发生率为每10万例分娩5.4例。
1996年至2007年加拿大孕产妇死亡率没有上升。加拿大生命统计数据中观察到的上升可能反映了孕产妇死亡确定方面的改善。住院数据可作为监测加拿大孕产妇死亡率趋势的及时且全面的来源。
