Departments of Obstetrics & Gynecology and Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Reprod Health. 2018 Jun 22;15(Suppl 1):98. doi: 10.1186/s12978-018-0527-2.
Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).
SEVERE MATERNAL MORBIDITY IN HIGH-INCOME COUNTRIES: Since the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify "high risk" status, delays in diagnosis, and delays in treatment.
The highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity.
Severe maternal morbidity not only puts the woman's life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn.
Increasing global maternal morbidity is a failure to achieve broad public health goals of improved women's and infants' health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.
孕产妇死亡率仍然是一个重大的公共卫生问题，但每一位因妊娠直接或间接死亡的妇女，都有更多的妇女经历危及生命的并发症。全球严重孕产妇发病率（SMM）的负担尚不清楚，但世界银行估计它随着时间的推移而增加。与孕产妇死亡率一致，中低收入国家（LMICs）的 SMM 发病率高于高收入国家（HICs）。
自世界卫生组织建议低孕产妇死亡率的 HICs 开始检查 SMM 以确定系统故障和干预重点以来，许多 HICs 的研究人员已将注意力转向 SMM。在进行监测的地方，SMM 最常见的病因是主要的产科出血和高血压疾病。在进行 SMM 审查的国家中，最常见的可预防因素与提供者有关，具体来说是未能识别“高风险”状态、诊断延迟和治疗延迟。
撒哈拉以南非洲的 SMM 负担最重，估计 SMM 发病率高达每 1000 例活产 198 例。出血和高血压疾病是所有地区导致 SMM 的主要疾病。病例审查很少见，但揭示了低标准的孕产妇保健和最佳使用基于证据的策略来预防和治疗发病率的模式。
SMM 对分娩结局和婴儿的影响：严重的孕产妇发病率不仅使妇女的生命处于危险之中，她的胎儿/新生儿也可能遭受发病率和死亡率的后果。患有 SMM 的妇女更频繁地发生不良分娩结局。减少可预防的严重孕产妇发病率不仅可以降低孕产妇死亡的可能性，还可以改善新生儿的健康和福祉。
全球孕产妇发病率的增加是未能实现改善妇女和婴儿健康的广泛公共卫生目标的失败。所有国家都有责任实施监测计划，了解严重发病率的负担，并实施评估潜在可预防因素的审查程序。
