Bolnga John W, Morris Marilyn, Totona Catherine, Laman Moses
Modilon Hospital, Madang, Papua New Guinea.
Department of Paediatrics, Modilon Hospital, Madang, Papua New Guinea.
Aust N Z J Obstet Gynaecol. 2017 Dec;57(6):624-629. doi: 10.1111/ajo.12650. Epub 2017 Jun 5.
Maternal near-miss indices are World Health Organisation (WHO) recognised indicators that may improve our understanding of factors associated with maternal morbidity and mortality. In Papua New Guinea (PNG) where maternal mortality is among the highest in the world, only one study has documented near-miss indices in a tertiary-level hospital, but none from provincial hospitals where the majority of under-privileged women access healthcare services.
To determine the near-miss ratio, maternal mortality index (MMI), and associated maternal indices for Modilon Hospital in Madang Province of PNG.
All women attending Modilon Hospital who met the WHO maternal near-miss definition and/or a WHO-modified (PNG-specific) near-miss definition, were prospectively enrolled.
There were 6019 live births during the audit period; 163 women presented with life-threatening conditions (153 near-misses and 10 maternal deaths). The maternal near-miss ratio was 25.4/1000 live births and the maternal mortality ratio (MMR) was 166/100 000 live births, with a maternal death to near-miss ratio of 1:15.3. The severe maternal outcome ratio was 27.1/1000 live births and the total mortality index was 6.8%. Higher proportions of near-miss women were aged ≥30 years, nulliparous, illiterate, from rural communities, lacked formal employment, referred from peripheral health facilities, unbooked, had history of still births and were anaemic.
Sociodemographic factors such as women's rights, education level and status in society, in addition to appropriate health reforms with greater financial and political support are urgently needed to ensure underprivileged women in rural PNG have access to family planning, supervised deliveries and skilled emergency obstetric care.
孕产妇接近死亡指数是世界卫生组织（WHO）认可的指标，有助于我们更好地理解与孕产妇发病和死亡相关的因素。在孕产妇死亡率位居世界前列的巴布亚新几内亚（PNG），仅有一项研究记录了一家三级医院的接近死亡指数，但尚无来自省级医院的相关记录，而大多数贫困妇女是在省级医院接受医疗服务的。
确定PNG马当省莫迪隆医院的接近死亡比率、孕产妇死亡指数（MMI）及相关孕产妇指数。
前瞻性纳入所有在莫迪隆医院就诊且符合WHO孕产妇接近死亡定义和/或WHO修改后的（PNG特定的）接近死亡定义的妇女。
审核期间有6019例活产；163名妇女出现危及生命的情况（153例接近死亡和10例孕产妇死亡）。孕产妇接近死亡比率为25.4/1000例活产，孕产妇死亡率（MMR）为166/100 000例活产，孕产妇死亡与接近死亡的比率为1:15.3。严重孕产妇结局比率为27.1/1000例活产，总死亡指数为6.8%。年龄≥30岁、未生育、文盲、来自农村社区、无正式工作、从周边卫生机构转诊、未登记、有死产史且贫血的接近死亡妇女比例更高。
迫切需要妇女权利、教育水平和社会地位等社会人口学因素，以及在更大的财政和政治支持下进行适当医疗改革，以确保PNG农村地区的贫困妇女能够获得计划生育、监护分娩和熟练的紧急产科护理。
