Saucedo Monica, Bouvier-Colle Marie-Hélène, Chantry Anne A, Lamarche-Vadel Agathe, Rey Grégoire, Deneux-Tharaux Catherine
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Paediatr Perinat Epidemiol. 2014 Nov;28(6):479-88. doi: 10.1111/ppe.12153. Epub 2014 Oct 30.
The lessons learned from the study of maternal deaths depend on the accuracy of data. Our objective was to assess time trends in the underestimation of maternal mortality (MM) in the national routine death statistics in France and to evaluate their current accuracy for the selection and causes of maternal deaths.
National data obtained by enhanced methods in 1989, 1999, and 2007-09 were used as the gold standard to assess time trends in the underestimation of MM ratios (MMRs) in death statistics. Enhanced data and death statistics for 2007-09 were further compared by characterising false negatives (FNs) and false positives (FPs). The distribution of cause-specific MMRs, as assessed by each system, was described.
Underestimation of MM in death statistics decreased from 55.6% in 1989 to 11.4% in 2007-09 (P < 0.001). In 2007-09, of 787 pregnancy-associated deaths, 254 were classified as maternal by the enhanced system and 211 by the death statistics; 34% of maternal deaths in the enhanced system were FNs in the death statistics, and 20% of maternal deaths in the death statistics were FPs. The hierarchy of causes of MM differed between the two systems. The discordances were mainly explained by the lack of precision in the drafting of death certificates by clinicians.
Although the underestimation of MM in routine death statistics has decreased substantially over time, one third of maternal deaths remain unidentified, and the main causes of death are incorrectly identified in these data. Defining relevant priorities in maternal health requires the use of enhanced methods for MM study.
从孕产妇死亡研究中吸取的经验教训取决于数据的准确性。我们的目标是评估法国国家常规死亡统计中孕产妇死亡率（MM）低估情况的时间趋势，并评估其目前在孕产妇死亡选择和原因方面的准确性。
将1989年、1999年以及2007 - 2009年通过强化方法获得的国家数据用作评估死亡统计中MM比率（MMRs）低估情况时间趋势的金标准。通过对假阴性（FNs）和假阳性（FPs）进行特征分析，进一步比较了2007 - 2009年的强化数据和死亡统计数据。描述了每个系统评估的特定原因MMRs的分布情况。
死亡统计中MM的低估率从1989年的55.6%降至2007 - 2009年的11.4%（P < 0.001）。在2007 - 2009年，787例与妊娠相关的死亡中，强化系统分类为孕产妇死亡的有254例，死亡统计分类为孕产妇死亡的有211例；强化系统中34%的孕产妇死亡在死亡统计中为FNs，死亡统计中20%的孕产妇死亡为FPs。两个系统中MM的原因层级不同。差异主要是由于临床医生开具死亡证明时缺乏精确性。
尽管常规死亡统计中MM的低估情况随着时间推移已大幅下降，但仍有三分之一的孕产妇死亡未被识别，且这些数据中主要死亡原因被错误识别。确定孕产妇健康的相关优先事项需要使用强化方法进行MM研究。
