Auckland District Health Board, Auckland, NZ; Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, NZ.
Am J Obstet Gynecol. 2013 Dec;209(6):549.e1-7. doi: 10.1016/j.ajog.2013.07.031. Epub 2013 Jul 31.
The purpose of this study was to identify factors that contributed to severe maternal morbidity, defined by admission of pregnant women and women in the postpartum period to the intensive care unit (ICU) from 2010-2011 at Auckland City Hospital (ACH), a tertiary hospital that delivers 7500 women/year, and to determine potentially avoidable morbidity with the use of local multidisciplinary review.
All admissions of pregnant women and women in the postpartum period (to 6 weeks) to the ICU at ACH from 2010-2011 were identified from hospital databases. Case notes were summarized and discussed by a multidisciplinary team. The presence of contributory factors and potentially avoidable morbidity were determined by consensus with a tool that was developed by the New Zealand Perinatal and Maternal Mortality Review Committee for the review of maternal and perinatal deaths. Specific recommendations for clinical management were identified by the multidisciplinary group.
Nine pregnant women and 33 women in the postpartum period were admitted to the ICU from 2010-2011. Contributory factors were identified in 30 cases (71%); 20 cases (48%) were considered to be potentially avoidable; personnel factors were the most commonly identified avoidable causes. Specific recommendations that resulted from the study included the need for the development of guidelines for puerperal sepsis, improved planning for women at known risk of postpartum hemorrhage, enhanced supervision of junior staff, and enhanced communication through multidisciplinary meetings.
Forty-eight percent of severe maternal morbidity, which was defined as admission to the ICU at ACH from 2010-2011, was considered to be potentially avoidable by a local multidisciplinary review team; priorities were identified for improvement of local maternity services.
本研究旨在确定导致重症产妇发病率的因素，重症产妇发病率定义为 2010-2011 年期间奥克兰城市医院（ACH）收治的孕妇和产后妇女入住重症监护病房（ICU）的人数，ACH 是一家每年分娩 7500 名妇女的三级医院。通过使用当地多学科审查，确定潜在可避免的发病率。
从医院数据库中确定 2010-2011 年期间 ACH 收治的所有孕妇和产后妇女（至 6 周）入住 ICU 的情况。通过多学科团队对病例记录进行总结和讨论。通过新西兰围产期和孕产妇死亡率审查委员会为审查孕产妇和围产期死亡而制定的工具，通过共识确定了促成因素和潜在可避免的发病率。多学科小组确定了具体的临床管理建议。
2010-2011 年期间，有 9 名孕妇和 33 名产后妇女入住 ICU。在 30 例（71%）中确定了促成因素；20 例（48%）被认为是潜在可避免的；人员因素是最常见的可避免原因。该研究提出的具体建议包括制定产褥期脓毒症指南、改善对已知产后出血风险妇女的计划、加强对初级工作人员的监督、通过多学科会议加强沟通等。
通过当地多学科审查小组，认为 2010-2011 年期间入住 ACH ICU 的重症产妇发病率的 48%是潜在可避免的；确定了改善当地产科服务的优先事项。
