Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, R, Alexander Fleming, 101, P, O, Box 6030, 13083-881 Campinas, São Paulo, Brazil.
Reprod Health. 2014 Jan 16;11(1):4. doi: 10.1186/1742-4755-11-4.
Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.
This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.
Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.
In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
在中低收入国家，高血压疾病是导致产妇发病率的主要原因。本研究的主要目的是确定患有严重高血压疾病的女性发生严重产妇不良结局的患病率和相关因素。
这是一项横断面、多中心研究，共纳入了来自巴西 27 家产科医院的 6706 例严重高血压疾病患者。对严重产妇发病率进行前瞻性监测，在一年时间内（2009 年至 2010 年），通过病历收集数据，并将其输入到在线系统 OpenClinica®中。本研究纳入了严重先兆子痫、严重高血压、子痫和 HELLP 综合征患者。根据不良结局（接近死亡、产妇死亡和潜在危及生命的情况）将患者分为不同组。计算了调整了聚类效应的产妇和围生期变量以及接受产科护理延迟的比值比和 95%置信区间，以评估发生严重产妇结局（接近死亡或死亡）的产妇并发症的风险。还进行了泊松多重回归分析。
严重高血压疾病是导致严重产妇发病率的主要原因（6706/9555）；接近死亡的患病率为每 1000 例活产 4.2 例，每 10 例接近死亡就有 1 例产妇死亡，死亡率指数为 10.7%（病死率）。疾病早期发作和产后出血是与严重产妇结局相关的独立变量，此外还包括急性肺水肿、既往心脏病和接受二级和三级护理的延迟。
在患有严重高血压疾病的女性中，本研究确定了与严重产妇结局独立相关的情况，这些情况可以通过干预产科护理和医疗保健系统来改变。此外，该研究还表明了医院系统监测严重产妇发病率的可行性。
