孕产妇near-miss 与不良围产结局风险：在埃塞俄比亚亚的斯亚贝巴选定公立医院的前瞻性队列研究。
Maternal near-miss and the risk of adverse perinatal outcomes: a prospective cohort study in selected public hospitals of Addis Ababa, Ethiopia.
机构信息
Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
BMC Pregnancy Childbirth. 2018 Aug 22;18(1):345. doi: 10.1186/s12884-018-1983-y.
BACKGROUND
Presence of maternal near-miss conditions in women is strongly associated with the occurrence of adverse perinatal outcomes, but not well-understood in low-income countries. The study aimed to ascertain the effect of maternal near-miss on the risk of adverse perinatal outcomes in Ethiopia.
METHODS
A prospective cohort study was conducted in five public hospitals of Addis Ababa, Ethiopia. Women admitted from May 1, 2015 to April 30, 2016 were recruited for the study. We followed a total of 828 women admitted for delivery or treatment of pregnancy-related complications along with their singleton newborn babies. Maternal near-miss was the primary exposure and was ascertained using the World Health Organization criteria. Women who delivered without complications were taken as the non-exposed groups. The main outcome was adverse perinatal outcomes. Data on maternal near-miss and perinatal outcomes were abstracted from medical records of the participants. Exposed and non-exposed women were interviewed by well-trained data collectors to obtain information about potential confounding factors. Logistic regressions were performed using Stata version 13.0 to determine the adjusted odds of adverse perinatal outcomes.
RESULTS
A total of 207 women with maternal near-miss and 621 women with uncomplicated delivery were included in the study. After adjusting for potential confounders, women with maternal near-miss condition had more than five-fold increased odds of adverse perinatal outcomes compared to women who delivered without any complications (AOR = 5.69: 95% CI; 3.69-8.76). Other risk factors that were independently associated with adverse perinatal outcomes include: rural residence, history of prior stillbirth and primary educational level.
CONCLUSIONS
Presence of maternal near-miss in women is an independent risk factor for adverse perinatal outcomes. Hence, interventions rendered at improvement in maternal health of Ethiopia can lead to an improvement in perinatal outcomes.
背景
产妇接近发病状态的存在与不良围产结局的发生密切相关，但在低收入国家还未得到很好的理解。本研究旨在确定产妇接近发病状态对埃塞俄比亚不良围产结局风险的影响。
方法
在埃塞俄比亚亚的斯亚贝巴的五所公立医院进行了一项前瞻性队列研究。2015 年 5 月 1 日至 2016 年 4 月 30 日期间，招募了因分娩或妊娠相关并发症治疗而入院的女性。我们总共招募了 828 名因分娩或治疗妊娠相关并发症而入院的女性及其单胎新生儿。产妇接近发病状态是主要暴露因素，使用世界卫生组织的标准来确定。无并发症分娩的女性被视为非暴露组。主要结局是不良围产结局。参与者的产妇接近发病状态和围产结局数据从病历中提取。通过受过良好培训的数据收集者对暴露和非暴露的女性进行访谈，以获取有关潜在混杂因素的信息。使用 Stata 版本 13.0 进行逻辑回归，以确定不良围产结局的调整后比值比。
结果
本研究共纳入 207 名产妇接近发病状态的女性和 621 名无并发症分娩的女性。在调整了潜在混杂因素后，与无任何并发症分娩的女性相比，产妇接近发病状态的女性发生不良围产结局的可能性高出五倍以上（AOR=5.69：95%CI；3.69-8.76）。与不良围产结局独立相关的其他危险因素包括：农村居住地、先前死胎史和小学教育水平。
结论
产妇接近发病状态的存在是不良围产结局的独立危险因素。因此，改善埃塞俄比亚产妇健康的干预措施可以改善围产结局。
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