Katsuragi Shinji, Tanaka Hiroaki, Hasegawa Junichi, Nakamura Masamitsu, Kanayama Naohiro, Nakata Masahiko, Murakoshi Takeshi, Yoshimatsu Jun, Osato Kazuhiro, Tanaka Kayo, Sekizawa Akihiko, Ishiwata Isamu, Ikeda Tomoaki
a Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan.
b Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan.
J Matern Fetal Neonatal Med. 2019 Oct;32(20):3420-3426. doi: 10.1080/14767058.2018.1465549. Epub 2018 Apr 26.
Hypertensive disorder of pregnancy (HDP) is a major cause of maternal death. The goal of this study was to investigate factors associated with maternal death due to HDP. HDP-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor and Welfare from 2010 to 2015 were examined. Out of 47 cases of HDP, 30 were identified as the major cause of maternal death. The median maternal age was 34 years (range 24-45) and the mortality in women aged ≥40 years was seven times higher that than in women aged <34 years. The etiologies were intracerebral hemorrhage ( = 22), subarachnoid hemorrhage ( = 3), subcapsular hematoma of the liver ( = 2), peripartum cardiomyopathy ( = 2), and eclampsia ( = 1), and 19 cases were deemed preventable. The most frequent antepartum problems were delays in hospitalization, maternal transfer, and termination of pregnancy. In four cases, diagnosis of HELLP syndrome was too late because laboratory data were not checked, despite the patient reporting epigastric pain or showing elevation of blood pressure (BP). Treatment for lowering of BP was improper in 2/3 intrapartum cases, even though BP was elevated during pregnancy (144 versus 188 mmHg, < .001). There was inadequate lowering of BP and lack of use of magnesium sulfate in 7/11 postpartum cases (64%), despite aspartate aminotransferase (AST) ( < .005), alanine aminotransferase (ALT) ( < .01), lactate dehydrogenase (LDH) ( < .005), and platelet count (PLT) ( < .01) all significantly worsening after delivery. HDP accounts for 11% of maternal deaths in Japan. Mothers aged ≥40 years are most at risk for HDP-related maternal death. Major concerns for preventabilities were late hospitalization, maternal transportation, and termination of pregnancy for term or near-term HDP. Regular vital checks and prompt lowering of BP were lacked during labor in most cases. HELLP syndrome should be managed at a general hospital with sufficient medical resources.
妊娠高血压疾病（HDP）是孕产妇死亡的主要原因。本研究的目的是调查与HDP所致孕产妇死亡相关的因素。对2010年至2015年向厚生劳动省委员会报告的日本HDP相关孕产妇死亡病例进行了调查。在47例HDP病例中，30例被确定为孕产妇死亡的主要原因。孕产妇年龄中位数为34岁（范围24 - 45岁），≥40岁女性的死亡率比<34岁女性高7倍。病因包括脑出血（= 22例）、蛛网膜下腔出血（= 3例）、肝包膜下血肿（= 2例）、围产期心肌病（= 2例）和子痫（= 1例），19例被认为是可预防的。最常见的产前问题是住院延迟、孕产妇转运和终止妊娠。在4例病例中，尽管患者报告有上腹部疼痛或血压（BP）升高，但由于未检查实验室数据，HELLP综合征的诊断太晚。在2/3的产时病例中，尽管孕期血压升高（144对188 mmHg，<0.001），但降压治疗不当。在11例产后病例中有7例（64%）降压不足且未使用硫酸镁，尽管分娩后天冬氨酸转氨酶（AST）（<0.005）、丙氨酸转氨酶（ALT）（<0.01）、乳酸脱氢酶（LDH）（<0.005）和血小板计数（PLT）（<0.01）均显著恶化。HDP占日本孕产妇死亡的11%。≥40岁的母亲发生HDP相关孕产妇死亡的风险最高。可预防性的主要问题是住院晚、孕产妇转运以及足月或近足月HDP的终止妊娠。大多数病例在分娩期间缺乏定期生命体征检查和及时降压。HELLP综合征应在具备充足医疗资源的综合医院进行处理。
