Herklots Tanneke, van Acht Lieke, Meguid Tarek, Franx Arie, Jacod Benoit
Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Stone Town, Zanzibar, United Republic of Tanzania.
PLoS One. 2017 Aug 23;12(8):e0181470. doi: 10.1371/journal.pone.0181470. eCollection 2017.
to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.
Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.
We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC), maternal near-miss (MNM) or maternal death (MD). Quality of in-hospital care was assessed using the mortality index (MI) defined as ratio between mortality and severe maternal outcome (SMO) where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model.
5551 women were included. 569 (10.3%) had a potentially life-threatening condition and 65 (1.2%) a severe maternal outcome (SMO): 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.
WHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.
在资源匮乏、死亡率高的桑给巴尔转诊医院，采用世界卫生组织的“near-miss”方法分析住院治疗对严重孕产妇发病的影响。
坦桑尼亚桑给巴尔的三级医疗机构姆纳齐莫贾医院。
我们确定了2016年4月至10月期间在姆纳齐莫贾医院妊娠结束后42天内入院的所有孕产妇发病和死亡病例。使用世界卫生组织的“near-miss”方法定义对并发症的严重程度进行分类：潜在危及生命状况（PLTC）、孕产妇near-miss（MNM）或孕产妇死亡（MD）。使用死亡率指数（MI）评估住院治疗质量，死亡率指数定义为死亡率与严重孕产妇结局（SMO）之比，其中SMO = MD + MNM，特定病因病例机构发生率，并与基于孕产妇严重程度指数模型预测的死亡率进行比较。
纳入5551名妇女。569名（10.3%）有潜在危及生命状况，65名（1.2%）有严重孕产妇结局（SMO）：37例孕产妇near-miss病例和28例孕产妇死亡。死亡率指数较高，为0.43，入院12小时内出现SMO的妇女与入院12小时后出现SMO的妇女相似。标准化死亡率为6.03；鉴于病例严重程度相同，比中度孕产妇死亡率环境中预期的高出六倍。产科出血被发现是SMO的主要原因。子宫破裂和入住重症监护病房的病死率最高。孕产妇死亡病例似乎较少接受基本干预措施。
世界卫生组织的“near-miss”方法可用于此环境。观察到的高死亡率指数表明，一旦出现严重并发症，住院治疗未能充分预防疾病进展。几乎每两名出现危及生命并发症的妇女中就有一人会死亡。这比中度死亡率环境高出六倍。
