Nair M, Kurinczuk J J, Brocklehurst P, Sellers S, Lewis G, Knight M
National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
BJOG. 2015 Apr;122(5):653-62. doi: 10.1111/1471-0528.13279. Epub 2015 Jan 9.
To investigate the factors associated with maternal death from direct pregnancy complications in the UK.
Unmatched case-control analysis.
All hospitals caring for pregnant women in the UK.
A total of 135 women who died (cases) between 2009 and 2012 from eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism, and peripartum haemorrhage, using data from the Confidential Enquiry into Maternal Death, and another 1661 women who survived severe complications (controls) caused by these conditions (2005-2013), using data from the UK Obstetric Surveillance System.
Multivariable regression analyses were undertaken to identify the factors that were associated with maternal deaths and to estimate the additive odds associated with the presence of one or more of these factors.
Odds ratios associated with maternal death and population-attributable fractions, with 95% confidence intervals. Incremental risk of death associated with the factors using a 'risk factors' score.
Six factors were independently associated with maternal death: inadequate use of antenatal care (adjusted odds ratio, aOR 15.87, 95% CI 6.73-37.41); substance misuse (aOR 10.16, 95% CI 1.81-57.04); medical comorbidities (aOR 4.82, 95% CI 3.14-7.40); previous pregnancy problems (aOR 2.21, 95% CI 1.34-3.62); hypertensive disorders of pregnancy (aOR 2.44, 95% CI 1.31-4.52); and Indian ethnicity (aOR 2.70, 95% CI 1.14-6.43). Of the increased risk associated with maternal death, 70% (95% CI 66-73%) could be attributed to these factors. Odds associated with maternal death increased by three and a half times per unit increase in the 'risk factor' score (aOR 3.59, 95% CI 2.83-4.56).
This study shows that medical comorbidities are importantly associated with direct (obstetric) deaths. Further studies are required to understand whether specific aspects of care could be improved to reduce maternal deaths among women with medical comorbidities in the UK.
调查英国与直接妊娠并发症导致孕产妇死亡相关的因素。
非匹配病例对照分析。
英国所有为孕妇提供护理的医院。
利用孕产妇死亡保密调查的数据，选取2009年至2012年间因子痫、肺栓塞、严重脓毒症、羊水栓塞和产后出血死亡的135名女性（病例组）；利用英国产科监测系统的数据，选取另外1661名在2005年至2013年间因这些病症出现严重并发症后存活的女性（对照组）。
进行多变量回归分析，以确定与孕产妇死亡相关的因素，并估计与存在一种或多种这些因素相关的相加比值比。
与孕产妇死亡相关的比值比和人群归因分数，以及95%置信区间。使用“危险因素”评分评估这些因素与死亡相关的增量风险。
六个因素与孕产妇死亡独立相关：产前护理利用不足（校正比值比，aOR 15.87，95%置信区间6.73 - 37.41）；药物滥用（aOR 10.16，95%置信区间1.81 - 57.04）；合并症（aOR 4.82，95%置信区间3.14 - 7.40）；既往妊娠问题（aOR 2.21，95%置信区间1.34 - 3.62）；妊娠高血压疾病（aOR 2.44，95%置信区间1.31 - 4.52）；以及印度族裔（aOR 2.70，95%置信区间1.14 - 6.43）。孕产妇死亡相关的增加风险中，70%（95%置信区间66 - 73%）可归因于这些因素。“危险因素”评分每增加一个单位，孕产妇死亡相关的比值比增加3.5倍（aOR 3.59，95%置信区间2.83 - 4.56）。
本研究表明，合并症与直接（产科）死亡密切相关。需要进一步研究以了解是否可以改进特定护理方面，以降低英国患有合并症女性的孕产妇死亡率。
