Morong James J, Martin Jane K, Ware Robert S, Colditz Paul B, Robichaux Alfred G
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, IL.
Ochsner J. 2017 Fall;17(3):243-249.
It is well documented that the American maternal mortality ratio has increased during the years 2000-2015. The Australian maternal mortality ratio, in contrast, has decreased during the same time period, a trend common among most Western countries.
This study was a retrospective cohort study of cases of in-hospital maternal deaths in the Ochsner Health System (Louisiana, United States) and the Queensland Health System (Australia) from 1995 to 2013. The aim was to determine if American and Australian women have a similar rate of preventable maternal death and if the deaths were attributable to the same factors. A multidisciplinary team assessed medical records to determine preventability.
Sixteen eligible medical records were identified in the Ochsner Health System and 15 in the Queensland Health System. In the American cohort, deaths in the private insurance group (n=5) were least likely to be preventable (=0.003). Australian maternal deaths were less likely to occur among women with late or no prenatal care than American maternal deaths; the risk difference was 44.5% for all deaths (95% confidence interval [CI]=9.7%, 79.4%; =0.03) and 50.0% for potentially preventable deaths (95% CI=9.3%, 90.6%; =0.04).
Women from Louisiana, United States and Queensland, Australia have similar rates of preventable maternal death. No statistically significant factors explained trends in Australian maternal death; American maternal mortality was significantly associated with point of entry into prenatal care, likely influenced by insurance status. Furthermore, the majority of deaths in this group were complicated by hospital systems-based factors.
有充分文献记载，美国孕产妇死亡率在2000 - 2015年期间有所上升。相比之下，澳大利亚孕产妇死亡率在同一时期有所下降，这是大多数西方国家常见的趋势。
本研究是一项回顾性队列研究，研究对象为1995年至2013年奥克施纳医疗系统（美国路易斯安那州）和昆士兰卫生系统（澳大利亚）的院内孕产妇死亡病例。目的是确定美国和澳大利亚女性可预防孕产妇死亡的发生率是否相似，以及死亡是否归因于相同因素。一个多学科团队评估病历以确定可预防性。
在奥克施纳医疗系统中识别出16份符合条件的病历，在昆士兰卫生系统中识别出15份。在美国队列中，私人保险组的死亡（n = 5）最不可能是可预防的（P = 0.003）。与美国孕产妇死亡相比，澳大利亚孕产妇死亡在产前护理延迟或未进行产前护理的女性中发生的可能性较小；所有死亡的风险差异为44.5%（95%置信区间[CI] = 9.7%，79.4%；P = 0.03），潜在可预防死亡的风险差异为50.0%（95% CI = 9.3%，90.6%；P = 0.04）。
美国路易斯安那州和澳大利亚昆士兰的女性可预防孕产妇死亡发生率相似。没有统计学上显著的因素解释澳大利亚孕产妇死亡的趋势；美国孕产妇死亡率与产前护理开始时间显著相关，可能受保险状况影响。此外，该组中的大多数死亡因基于医院系统的因素而复杂化。
