Tanimia Hilda, Jayaratnam Skandarupan, Mola Glen L, Amoa Apeawusu B, de Costa Caroline
Division of Obstetrics and Gynaecology, Port Moresby General Hospital, Boroko, Papua New Guinea.
James Cook University College of Medicine, Cairns, Qld, Australia.
Aust N Z J Obstet Gynaecol. 2016 Apr;56(2):148-53. doi: 10.1111/ajo.12430. Epub 2016 Feb 3.
The World Health Organization (WHO) defines 'maternal near-miss' as 'a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of her pregnancy'. With declining rates of maternal mortality, near-miss analysis is being examined in both developed and developing country settings for the assessment of obstetric care.
Over a 15-month period, details of cases that could be classified as 'near-misses' were collected at Port Moresby General Hospital (PMGH), to assess the practicality of collecting such data routinely and determine near-miss rates for the hospital.
Information about all cases that fitted the WHO definition of 'near-miss' was collected prospectively.
During the audit period, there were 13 338 live births at PMGH; 131 women presented with a life-threatening condition of whom 122 met WHO criteria for 'maternal near-miss'; there were nine maternal deaths. The maternal mortality ratio was 67.5/100 000 live births, the maternal near-miss index ratio 9.1/1000 live births and the combination of maternal deaths and near-misses gave a severe maternal outcome ratio of 9.8/1000 live births. Main causes of the 'near-misses' were obstetric haemorrhage, hypertensive disorders and infections. Grandmultiparity, nulliparity, no antenatal attendance and age beyond 30 years were associated with maternal near-misses.
Assessment of near-misses equivalent to that provided in developed countries is possible in less well-resourced settings such as PMGH. Knowledge of causes of near-misses will assist health professionals to anticipate or prevent devastating maternal morbidities and thereby improve maternal and perinatal outcomes.
世界卫生组织（WHO）将“孕产妇险些死亡”定义为“一名女性险些死亡，但在孕期、分娩期间或终止妊娠后42天内发生的并发症中存活下来”。随着孕产妇死亡率的下降，发达国家和发展中国家都在对险些死亡情况进行分析，以评估产科护理。
在15个月的时间里，莫尔斯比港总医院（PMGH）收集了可归类为“险些死亡”病例的详细信息，以评估常规收集此类数据的实用性，并确定该医院的险些死亡率。
前瞻性收集所有符合WHO“险些死亡”定义的病例信息。
在审核期间，PMGH有13338例活产；131名女性出现危及生命的情况，其中122名符合WHO“孕产妇险些死亡”标准；有9例孕产妇死亡。孕产妇死亡率为67.5/10万活产，孕产妇险些死亡指数率为9.1/1000活产，孕产妇死亡和险些死亡的综合严重孕产妇结局率为9.8/1000活产。“险些死亡”的主要原因是产科出血、高血压疾病和感染。多产、初产、未进行产前检查以及年龄超过30岁与孕产妇险些死亡有关。
在资源较少的环境中，如PMGH，进行与发达国家相当的险些死亡情况评估是可能的。了解险些死亡的原因将有助于卫生专业人员预测或预防严重的孕产妇发病情况，从而改善孕产妇和围产儿结局。
