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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).《脓毒症及脓毒性休克第三次国际共识定义（脓毒症-3）》
JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
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The role of infection and sepsis in the Brazilian Network for Surveillance of Severe Maternal Morbidity.感染与脓毒症在巴西严重孕产妇发病监测网络中的作用。
Trop Med Int Health. 2016 Feb;21(2):183-93. doi: 10.1111/tmi.12633. Epub 2015 Dec 9.
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Network for Surveillance of Severe Maternal Morbidity: a powerful national collaboration generating data on maternal health outcomes and care.严重孕产妇发病率监测网络：一个强大的国家级协作网络，旨在生成有关孕产妇健康结局和护理的数据。
BJOG. 2016 May;123(6):946-53. doi: 10.1111/1471-0528.13614. Epub 2015 Sep 28.
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Global causes of maternal death: a WHO systematic analysis.全球孕产妇死亡原因：世卫组织系统分析。
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Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.严重孕产妇不良结局的间接原因：世卫组织孕产妇和新生儿健康多国调查的二次分析。
BJOG. 2014 Mar;121 Suppl 1:32-9. doi: 10.1111/1471-0528.12647.
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Obstetric transition: the pathway towards ending preventable maternal deaths.产科转型：终结可预防孕产妇死亡之路。
BJOG. 2014 Mar;121 Suppl 1:1-4. doi: 10.1111/1471-0528.12735.
7
[Maternal mortality and development: the obstetric transition in Brazil].[孕产妇死亡率与发展：巴西的产科转型]
Rev Bras Ginecol Obstet. 2013 Dec;35(12):533-5. doi: 10.1590/s0100-72032013001200001.
8
Maternal Mortality in a Tertiary Care Hospital: A 10-year Review.三级护理医院的孕产妇死亡率：十年回顾
Int J Prev Med. 2013 Jan;4(1):105-9.
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Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.拯救脓毒症运动：严重脓毒症和脓毒性休克管理国际指南：2012 年。
Crit Care Med. 2013 Feb;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af.
10
Implementing a maternal mortality surveillance system in Morocco - challenges and opportunities.在摩洛哥实施孕产妇死亡率监测系统 - 挑战与机遇。
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产科转型过程中孕产妇发病和死亡间接原因的负担：一项横断面多中心研究。

The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Process of Obstetric Transition: A Cross-Sectional Multicenter Study.

作者信息

Cirelli Jessica Fernandes, Surita Fernanda Garanhani, Costa Maria Laura, Parpinelli Mary Angela, Haddad Samira Maerrawi, Cecatti José Guilherme

机构信息

Department of Obsterics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.

出版信息

Rev Bras Ginecol Obstet. 2018 Mar;40(3):106-114. doi: 10.1055/s-0038-1623511. Epub 2018 Apr 2.

DOI:10.1055/s-0038-1623511
PMID:29609192
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10316919/
Abstract

OBJECTIVE

The aim of this study is to evaluate the burden of indirect causes of maternal morbidity/mortality in Brazil.

METHODS

Secondary analysis of a multicenter cross-sectional study conducted in 27 referral obstetric units within the Brazilian Network for Surveillance of Severe Maternal Morbidity.

RESULTS

A total of 82,388 women were surveilled: 9,555 women with severe maternal morbidity were included, and 942 (9.9%) of them had indirect causes of morbidity/mortality. There was an increased risk of higher severity among the indirect causes group, which presented 7.56 times increased risk of maternal death (prevalence ratio [PR]: 7.56; 95% confidence interval [95%CI]: 4.99-11.45). The main indirect causes of maternal death were H1N1 influenza, sepsis, cancer and cardiovascular disease. Non-public antenatal care (PR: 2.52; 95%CI: 1.70-3.74), diabetes (PR: 1.90; 95%CI: 1.24-2.90), neoplasia (PR: 1.98; 95%CI: 1.25-3.14), kidney diseases (PR: 1.99; 95%CI: 1.14-3.49), sickle cell anemia (PR: 2.50; 95%CI: 1.16-5.41) and drug addiction (PR: 1.98; 95%CI: 1.03-3.80) were independently associated with worse results in the indirect causes group. Some procedures for the management of severity were more common for the indirect causes group.

CONCLUSION

Indirect causes were present in less than 10% of the overall cases, but they represented over 40% of maternal deaths in the current study. Indirect causes of maternal morbidity/mortality were also responsible for an increased risk of higher severity, and they were associated with worse maternal and perinatal outcomes. In middle-income countries there is a mix of indirect causes of maternal morbidity/mortality that points to some advances in the scale of obstetric transition, but also reveals the fragility of health systems.

摘要

目的

本研究旨在评估巴西孕产妇发病/死亡间接原因的负担。

方法

对巴西严重孕产妇发病监测网络内27个转诊产科单位进行的多中心横断面研究进行二次分析。

结果

共监测了82388名妇女：纳入了9555名患有严重孕产妇疾病的妇女，其中942名（9.9%）有发病/死亡的间接原因。间接原因组中病情严重程度较高的风险增加，孕产妇死亡风险增加了7.56倍（患病率比[PR]：7.56；95%置信区间[95%CI]：4.99 - 11.45）。孕产妇死亡的主要间接原因是甲型H1N1流感、败血症、癌症和心血管疾病。非公共产前护理（PR：2.52；95%CI：1.70 - 3.74）、糖尿病（PR：1.90；95%CI：1.24 - 2.90）、肿瘤形成（PR：1.98；95%CI：1.25 - 3.14）、肾脏疾病（PR：1.99；95%CI：1.14 - 3.49）、镰状细胞贫血（PR：2.50；95%CI：1.16 - 5.41）和药物成瘾（PR：1.98；95%CI：1.03 - 3.80）与间接原因组的较差结果独立相关。一些严重程度管理程序在间接原因组中更为常见。

结论

间接原因在总体病例中占比不到10%，但在本研究中占孕产妇死亡的40%以上。孕产妇发病/死亡的间接原因也导致病情严重程度较高的风险增加，并与孕产妇和围产期结局较差相关。在中等收入国家，孕产妇发病/死亡的间接原因多种多样，这表明在产科转型规模方面取得了一些进展，但也揭示了卫生系统的脆弱性。