Department of Applied Research and Evaluation, National Initiative for Children's Healthcare Quality (NICHQ), Boston, MA, USA.
BMC Pregnancy Childbirth. 2013 Nov 19;13:213. doi: 10.1186/1471-2393-13-213.
Maternal morbidity estimations are not based on well-documented methodologies and thus have limited validity for informing efforts to address the issue and improve maternal health. To fill this gap, maternal morbidity needs to be clearly defined, driving the development of tools and indicators to measure and monitor maternal health. This article describes the scoping exercise conducted by the World Health Organization's Department of Reproductive of Health and Research (WHO/RHR), as an essential first step in this process.
A literature review was conducted to identify the range of definitions and conditions included in various studies of maternal morbidity with a special focus on the similarities and discrepancies of the definitions used across the studies. Furthermore a questionnaire was developed which included sections on key areas identified during the review and was sent out electronically to 130 international experts in the field of maternal health.
Maternal morbidities have been categorized in a variety of ways based on the causes, types of complications, and/or timeline. Issues regarding the time frame, severity, identification and classification and demographics were identified as key areas in the literature that require further investigation to achieve consensus on a maternal morbidity definition. Fifty-five (N = 55) individuals responded with completed questionnaires. Respondents' views on the time frame for the postpartum period varied from 6 weeks to beyond one year postpartum, it was noted that time frame depended on the type of complication. The majority of respondents said maternal morbidity should comprise a continuum of severity, whereas the identification of the cases should use a mixed criteria employing multiple methods.
Significant discrepancy in literature and expert opinion exists concerning elements of a maternal morbidity definition. There is a clear need for a concrete definition that would allow for consistent measurement and monitoring of maternal morbidity across settings and time.
孕产妇发病率的估计依据不是经过充分论证的方法，因此在为解决这一问题和改善孕产妇健康提供信息方面的有效性有限。为了弥补这一空白，需要明确孕产妇发病率的定义，从而推动开发衡量和监测孕产妇健康的工具和指标。本文介绍了世界卫生组织生殖健康和研究司（WHO/RHR）进行的范围界定工作，这是这一过程的必要的第一步。
进行了文献综述，以确定各种孕产妇发病率研究中包含的定义和状况范围，特别关注研究中使用的定义的相似之处和差异。此外，还开发了一份问卷，其中包括审查过程中确定的关键领域，并通过电子邮件发送给孕产妇健康领域的 130 名国际专家。
根据病因、并发症类型和/或时间线，孕产妇发病率已经以各种方式进行了分类。文献中确定了与时间框架、严重程度、识别和分类以及人口统计学有关的问题，这些问题需要进一步研究，以就孕产妇发病率定义达成共识。55 人（N=55）回复了完整的问卷。受访者对产后 6 周至 1 年以上的产后时间框架的看法各不相同，据指出，时间框架取决于并发症的类型。大多数受访者表示，孕产妇发病率应包含严重程度的连续体，而病例的识别应采用采用多种方法的混合标准。
文献和专家意见在孕产妇发病率定义的要素方面存在明显差异。显然需要一个具体的定义，以便在不同环境和时间内对孕产妇发病率进行一致的衡量和监测。
