Population Health Research Centre (CISAP: Centro de Investigación en Salud Poblacional), Hospital Durand, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Pan American Health Organization (PAHO), CABA, Argentina.
BJOG. 2013 Dec;120(13):1685-94; discussion 1944-5. doi: 10.1111/1471-0528.12395. Epub 2013 Aug 13.
To analyse life-threatening obstetric complications that occurred in public hospitals in Argentina.
Multicentre collaborative cross-sectional study.
Twenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area.
Women giving birth in participating hospitals during a 1-year period.
All cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively.
Identification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate.
A total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100 000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7).
This study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM.
分析阿根廷公立医院发生的危及生命的产科并发症。
多中心协作横断面研究。
布宜诺斯艾利斯大都市区围产期网络中的 25 家医院。
在参与医院分娩的妇女在 1 年内。
所有严重产妇发病率（SMM）和产妇死亡率（MM）病例均包括妊娠（包括流产和人工流产）、分娩和产褥期。数据是前瞻性收集的。
SMM 的识别标准、主要原因和发生率；病死率、发病率死亡率指数和有效干预措施使用率。
共发现 552 例危及生命的情况：518 例 SMM，34 例 MM。SMM 的识别标准为病例管理（48.9%）、器官功能障碍（15.2%）和混合标准（35.9%）。SMM 的发生率为 0.8%（95%置信区间[95%CI] 0.73-0.87%），医院产妇死亡率为每 100 000 例活产 52.3（95%CI 35.5-69.1）。MM 的主要原因是流产并发症和产褥期败血症；SMM 的主要原因是产后出血和高血压。总体病死率为 6.2%（95%CI 4.4-8.6）：最高的是败血症（14.8%）和流产并发症（13.3%）。发病率死亡率指数为 15:1（95%CI 7.5-30.8）。预防或治疗 MM 和 SMM 主要原因的已知有效干预措施使用率为 52.3%（95%CI 46.9-57.7）。
本研究描述了在具有全面产科护理的公立医院发生的危及生命的产科并发症的重要性，以及对可能降低 SMM 和 MM 发生率的已知有效干预措施的低利用率。它还提供了理由，证明需要开发一个 SMM 监测系统。
