Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Obstet Gynecol. 2013 Sep;122(3):627-33. doi: 10.1097/AOG.0b013e3182a06f4e.
To examine the effect of underlying maternal morbidities on the odds of maternal death during delivery hospitalization.
We used data that linked birth certificates to hospital discharge diagnoses from singleton live births at 22 weeks of gestation or later during 1995-2003 in New York City. Maternal morbidities examined included prepregnancy weight more than 114 kilograms (250 pounds), chronic hypertension, pregestational or gestational diabetes mellitus, chronic cardiovascular disease, pulmonary hypertension, chronic lung disease, human immunodeficiency virus (HIV), and preeclampsia or eclampsia. Associations with maternal mortality were estimated using multivariate logistic regression.
During the specified time period, 1,084,862 live singleton births and 132 maternal deaths occurred. Patients with increasing maternal age, non-Hispanic black ethnicity, self-pay or Medicaid, primary cesarean delivery, and premature delivery had higher rates of maternal mortality during delivery hospitalization. From the entire study population, 4.1% had preeclampsia or eclampsia (n=44,004), 1.8% had chronic hypertension (n=19,647), 1.1% of patients were classified as obese (n=11,936), 0.7% had pregestational diabetes (n=7,474), 0.4% had HIV (n=4,665), and 0.01% had pulmonary hypertension (n=166). Preeclampsia or eclampsia (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 5.5-12.1), chronic hypertension (adjusted OR, 7.7; 95% CI 4.7-12.5), underlying maternal obesity (adjusted OR, 2.9; 95% CI 1.1-8.1), pregestational diabetes (adjusted OR, 3.3; 95% CI 1.3-8.1), HIV (adjusted OR, 7.7; 95% CI 3.4-17.8), and pulmonary hypertension (adjusted OR, 65.1; 95% CI 15.8-269.3) were associated with an increased risk of death during the delivery hospitalization.
The presence of maternal disease significantly increases the odds of maternal mortality at the time of delivery hospitalization.
II.
探讨基础产妇合并症对分娩住院期间产妇死亡风险的影响。
我们使用了一项数据，该数据将 1995 年至 2003 年间在纽约市 22 周或以上的单胎活产的出生证明与医院出院诊断相联系。检查的产妇合并症包括孕前体重超过 114 公斤（250 磅）、慢性高血压、孕前或妊娠糖尿病、慢性心血管疾病、肺动脉高压、慢性肺部疾病、人类免疫缺陷病毒（HIV）和子痫前期或子痫。使用多变量逻辑回归估计与产妇死亡相关的关联。
在指定的时间段内，有 1084862 例活产单胎和 132 例产妇死亡。产妇年龄增长、非西班牙裔黑人种族、自费或医疗补助、初次剖宫产分娩和早产的患者在分娩住院期间的产妇死亡率更高。在整个研究人群中，4.1%的患者患有子痫前期或子痫（n=44004），1.8%的患者患有慢性高血压（n=19647），1.1%的患者被归类为肥胖（n=11936），0.7%的患者患有孕前糖尿病（n=7474），0.4%的患者患有 HIV（n=4665），0.01%的患者患有肺动脉高压（n=166）。子痫前期或子痫（调整后的优势比[OR]，8.1；95%置信区间[CI]，5.5-12.1）、慢性高血压（调整后的 OR，7.7；95% CI 4.7-12.5）、基础产妇肥胖（调整后的 OR，2.9；95% CI 1.1-8.1）、孕前糖尿病（调整后的 OR，3.3；95% CI 1.3-8.1）、HIV（调整后的 OR，7.7；95% CI 3.4-17.8）和肺动脉高压（调整后的 OR，65.1；95% CI 15.8-269.3）与分娩住院期间死亡风险增加相关。
产妇疾病的存在显著增加了分娩住院期间产妇死亡的风险。
II 级。
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