津巴布韦哈拉雷公共卫生部门产妇严重可避免不良结局的发生率：一项前瞻性描述性研究。
Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study.
机构信息
Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Central Hospital, P O Box ST 14, Southerton, Harare, Zimbabwe.
出版信息
BMC Pregnancy Childbirth. 2018 Nov 26;18(1):458. doi: 10.1186/s12884-018-2092-7.
BACKGROUND
Maternal 'near miss' can be a proxy for maternal death and it describes women who nearly died due to obstetric complications. It measures life threatening pregnancy related complications and allows the assessment of the quality of obstetric care.
METHODS
A prospective descriptive study was carried out from October 1 2016 to 31 December 2016, using the WHO criteria for maternal 'near miss' at the two tertiary public hospitals which receive referrals of all obstetric complications in Harare city, Zimbabwe. The objective was to calculate the ratio of maternal 'near miss' and associated factors. All pregnant women who developed life threatening complications classified as maternal near miss using the WHO criteria were recruited and followed up for six weeks from discharge, delivery or termination of pregnancy or up to the time of death.
RESULTS
During this period there were 11,871 births. One hundred and twenty three (123) women developed severe maternal outcomes, 110 were maternal 'near miss' morbidity and 13 were maternal deaths. The maternal 'near miss' ratio was 9.3 per 1000 deliveries, the mortality index (MI) was 10.6% and the maternal mortality ratio was 110 per 100,000 deliveries. The major organ dysfunction among cases with severe maternal outcomes (SMO) was cardiovascular dysfunction (76.9%). The major causes of maternal near miss were obstetric haemorrhage (31.8%), hypertensive disorders (28.2%) and complications of miscarriages (20%). The intensive care unit (ICU) admission rate was 7.3 per 100 cases of SMO and 88.8% of maternal deaths occurred without ICU admission.
CONCLUSION
The MNM ratio was comparable to that in the region. Obstetric haemorrhage was a leading cause of severe maternal morbidity though with less mortality when compared to hypertensive disorders and abortion complications. Zimbabwe should adopt maternal near miss ratio as an indicator for evaluating its maternal health services.
背景
产妇“near miss（接近死亡）”可以作为产妇死亡的替代指标，用于描述因产科并发症而险些死亡的女性。它衡量了危及生命的妊娠相关并发症，并评估了产科护理的质量。
方法
本研究于 2016 年 10 月 1 日至 12 月 31 日期间，在津巴布韦哈拉雷市的两家三级公立医院进行了一项前瞻性描述性研究，采用世界卫生组织（WHO）的产妇“near miss”标准。目的是计算产妇“near miss”的比例及其相关因素。所有出现危及生命的并发症并根据 WHO 标准被归类为产妇“near miss”的孕妇均被招募并随访 6 周，从出院、分娩或终止妊娠开始，或直至死亡。
结果
在此期间，共有 11871 例分娩。123 名女性出现严重产妇结局，110 名女性为产妇“near miss”病例，13 名女性死亡。产妇“near miss”的比例为每 1000 例分娩中有 9.3 例，死亡率指数（MI）为 10.6%，孕产妇死亡率为每 10 万例分娩中有 110 例。严重产妇结局（SMO）患者中主要器官功能障碍是心血管功能障碍（76.9%）。产妇“near miss”的主要原因是产科出血（31.8%）、高血压疾病（28.2%）和流产并发症（20%）。重症监护病房（ICU）的入院率为每 100 例 SMO 中有 7.3 例，88.8%的孕产妇死亡发生时未入住 ICU。
结论
该研究的 MNM 比例与该地区相似。尽管产科出血导致的严重产妇发病率较高，但与高血压疾病和流产并发症相比，其死亡率较低。津巴布韦应采用产妇“near miss”比例作为评估其孕产妇保健服务的指标。
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