Morong James J, Martin Jane K, Ware Robert S, Robichaux Alfred G
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.
Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA, USA.
Int J Gynaecol Obstet. 2017 Mar;136(3):344-349. doi: 10.1002/ijgo.12074. Epub 2017 Jan 14.
To determine preventability of in-hospital maternal mortality in the Ochsner Health System (OHS) in the US state of Louisiana.
A retrospective study was undertaken of all known cases of in-hospital maternal death (during pregnancy or within 42 days of termination) that occurred within OHS facilities in 1995-2013. Associations between characteristics and mortality and preventability were investigated. Incidence rate ratios (IRRs) were calculated in view of varying reference values.
Among 16 eligible deaths, 12 (75%) were deemed potentially preventable. The incidences of overall and preventable maternal death were higher if the patient had late entry to prenatal care (IRR 6.3 [P=0.004] and 8.8 [P=0.004], respectively). Maternal mortality was increased if the patient had required transfer to the OHS (IRR 15.8 [P<0.001] overall and 15.8 [P=0.002] for preventable mortality). Deaths of patients with private insurance were more likely to be not preventable than were those of patients without such insurance (P=0.003). Uninsured patients had the highest MMR, with an IRR of 13.8 (P=0.014) when compared with Medicaid patients.
The factors most predictive of mortality were late entry to prenatal care, critical status requiring transfer from an outside facility, and non-private insurance status.
确定美国路易斯安那州奥克施纳医疗系统（OHS）中住院孕产妇死亡的可预防性。
对1995 - 2013年期间在OHS医疗机构内发生的所有已知住院孕产妇死亡病例（孕期或终止妊娠后42天内）进行回顾性研究。调查了特征与死亡率及可预防性之间的关联。鉴于参考值不同，计算了发病率比（IRR）。
在16例符合条件的死亡病例中，12例（75%）被认为可能可预防。如果患者产前检查开始时间晚，则总体孕产妇死亡和可预防孕产妇死亡的发生率更高（发病率比分别为6.3 [P = 0.004]和8.8 [P = 0.004]）。如果患者需要转至OHS，孕产妇死亡率会增加（总体发病率比为15.8 [P < 0.001]，可预防死亡率的发病率比为15.8 [P = 0.002]）。与没有私人保险的患者相比，有私人保险的患者死亡更有可能不可预防（P = 0.003）。与医疗补助患者相比，未参保患者的孕产妇死亡率最高，发病率比为13.8（P = 0.014）。
最能预测死亡率的因素是产前检查开始时间晚、因危急状况需要从外部机构转来以及非私人保险状态。
