INSERM U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France.
Obstet Gynecol. 2013 Oct;122(4):752-760. doi: 10.1097/AOG.0b013e31829fc38c.
To assess trends in the maternal mortality ratio over a 10-year period in France and the causes, risk factors, quality of care, and avoidability of maternal deaths.
Maternal deaths up to 1 year after the end of the pregnancy from 1998 to 2007 were identified and studied through the French Confidential Enquiry Into Maternal Deaths system. Time trends were analyzed by comparing the two 5-year periods for maternal mortality ratios, both overall and by women's characteristics, causes of death, existence of suboptimal care, and avoidability.
For the 10-year period, 660 maternal deaths were identified. The maternal mortality ratio was similar in the two 5-year periods, 8.8 per 100,000 live births (95% confidence interval [CI] 7.8-9.8) for 1998-2002 and 8.4 per 100,000 live births (95% CI 7.6-9.4) for 2003-2007. The distributions of maternal age, nationality, and of causes of death did not change. Overall, hemorrhage was the leading cause of death, responsible for 18% of maternal deaths, followed by amniotic fluid embolism, thromboembolism, hypertensive disorders, and cardiovascular conditions, each of which contributed to 10-12% of deaths. Suboptimal care decreased from 70% in 1998-2002 to 60% in 2003-2007 (P<.03). Half of all deaths were considered avoidable and this proportion did not change. The most frequent contributory factor was inadequate management.
The ratio and profile of maternal mortality in France remained unchanged from 1998 to 2007. Half of all maternal deaths are still considered avoidable, which indicates that improvement remains possible.
: III.
评估法国 10 年来孕产妇死亡率的变化趋势以及孕产妇死亡的原因、风险因素、医疗质量和可避免性。
通过法国孕产妇死亡机密调查系统，确定了 1998 年至 2007 年期间分娩后 1 年内的孕产妇死亡病例，并对其进行了研究。通过比较两个 5 年期间的孕产妇死亡率，包括整体和按妇女特征、死亡原因、存在次优护理以及可避免性进行比较，对时间趋势进行了分析。
在这 10 年期间，共确定了 660 例孕产妇死亡病例。两个 5 年期间的孕产妇死亡率相似，1998-2002 年为每 10 万活产儿 8.8 例（95%置信区间[CI]为 7.8-9.8），2003-2007 年为每 10 万活产儿 8.4 例（95% CI 为 7.6-9.4）。孕产妇年龄、国籍和死亡原因的分布没有改变。总体而言，出血是导致死亡的主要原因，占孕产妇死亡的 18%，其次是羊水栓塞、血栓栓塞、高血压疾病和心血管疾病，各占 10-12%的死亡。次优护理从 1998-2002 年的 70%下降到 2003-2007 年的 60%（P<.03）。一半的死亡被认为是可以避免的，这一比例没有改变。最常见的促成因素是管理不当。
1998 年至 2007 年期间，法国的孕产妇死亡率和构成保持不变。仍有一半的孕产妇死亡被认为是可以避免的，这表明仍有可能改进。
III 级。
