Lindsay Michael K, Goodman David, Csukas Seema, Cota Pat, Loucks Tammy L, Ellis Jane E
Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and the Division of Health Promotion, Maternal and Child Health, Georgia Department of Public Health, Atlanta, Georgia; and the Georgia Obstetrical and Gynecological Society, Duluth, Georgia.
Obstet Gynecol. 2017 Sep;130(3):636-640. doi: 10.1097/AOG.0000000000002204.
The pregnancy-related mortality ratio in the United States has increased over the past 25 years. Georgia's pregnancy-related mortality ratio is among the highest in the United States. Confronted with this harsh reality, Georgia reestablished maternal mortality review as one strategy to address its high maternal mortality. To achieve a comprehensive process for review of maternal deaths involved securing the knowledge, resources, and support of physician experts, public health agencies and professional organizations as well as representatives in the state legislature. The six key steps in successfully reinstating maternal mortality review were 1) establishing a maternal mortality advisory committee, 2) developing a defined methodology for comprehensive case identification, 3) convening an introductory maternal mortality review committee meeting, 4) securing legislative protection for the committee, 5) conducting a mock mortality review, and 6) completing a formal first-year case review and producing a summary report of initial findings. This first case review revealed the leading causes of pregnancy-related deaths in Georgia as hemorrhage, hypertension, cardiac disease, embolism, and seizures. Our objective in this commentary is to share our experiences and advocate for engaging public, private, and academic partners in working on complex and multifactorial public health issues such as high maternal mortality.
在过去25年里,美国与妊娠相关的死亡率有所上升。佐治亚州与妊娠相关的死亡率在美国位居前列。面对这一严峻现实,佐治亚州重新启动了孕产妇死亡审查,将其作为应对该州高孕产妇死亡率的一项策略。要实现对孕产妇死亡进行全面审查的过程,需要获得医生专家、公共卫生机构、专业组织以及州立法机构代表的知识、资源和支持。成功恢复孕产妇死亡审查的六个关键步骤是:1)成立孕产妇死亡咨询委员会;2)制定全面病例识别的明确方法;3)召开孕产妇死亡审查委员会介绍会;4)为委员会争取立法保护;5)进行模拟死亡审查;6)完成正式的第一年病例审查并撰写初步调查结果总结报告。首次病例审查揭示了佐治亚州与妊娠相关死亡的主要原因是出血、高血压、心脏病、栓塞和癫痫发作。在这篇评论中,我们的目的是分享我们的经验,并倡导让公共、私营和学术伙伴参与处理诸如高孕产妇死亡率这类复杂的多因素公共卫生问题。