伊朗基于 ICD-MM 的孕产妇死亡率的决定因素和原因：系统评价。
Determinants and causes of maternal mortality in Iran based on ICD-MM: a systematic review.
机构信息
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Reprod Health. 2019 Feb 8;16(1):16. doi: 10.1186/s12978-019-0676-y.
BACKGROUND
No systematic review has explored the causes of and factors associated with maternal mortality in the context of Iran. This study reviewed determinants and causes of maternal mortalities during pregnancy, delivery and the puerperium using the International Classification of Diseases-Maternal Mortality (ICD-MM), introduced by the World Health Organization.
METHODS
A systematic electronic search of all the studies that identified causes and/or determinants of maternal deaths in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies to include in this study, a combination of hand searching and bibliographies was also conducted. These sources and citations yielded a total of 653 articles; nevertheless, only 29 articles met the inclusion criteria, hence, required data were extracted, summarized, and grouped together from these papers and are reported in the tables.
RESULTS
Amongst the 29 studies published between 2003 and 2017 in Iran, 24 studies were cross-sectional. Overall, 4633 deaths were reviewed, and 2655 (58%) of the cases included the data on the causes of death generally. According to the ICD-MM, a total of 69.9, 20.6, and 5.2% of the mortalities were due to direct, indirect and unspecified causes respectively and 4.3% of the causes were not clear in several studies. The leading direct and indirect causes of death were identified as hemorrhage (30.7%) and hypertensive disorders (17.1%) and circulatory system diseases (8.1%) respectively. Several factors including gravidity, type of delivery, socio-economic status of mothers, locations of birth, death and maternity care venues were found in the original studies as the most important determinant of maternal mortalities in Iran.
CONCLUSIONS
This study, provided an updated summary of evidences on the causes and determinants of maternal death in Iran, which is critically important for the development of interventions and reduction of the burden of maternal mortality and morbidities.
背景
目前尚无系统评价探讨伊朗孕产妇死亡的原因和相关因素。本研究使用世界卫生组织（WHO）推出的《国际疾病分类-孕产妇死亡》（ICD-MM），对妊娠期、分娩期和产褥期孕产妇死亡的决定因素和原因进行了综述。
方法
系统检索了所有在伊朗任何地区或全国范围内确定孕产妇死亡原因和/或决定因素的研究，不限制研究的时间或语言。为了确定纳入本研究的研究，还结合了手工检索和参考文献检索。这些来源和引文共产生了 653 篇文章；然而，只有 29 篇文章符合纳入标准，因此，从这些论文中提取、总结和汇总了所需的数据，并在表格中报告。
结果
在 2003 年至 2017 年期间在伊朗发表的 29 项研究中，有 24 项为横断面研究。总体而言，共回顾了 4633 例死亡，其中 2655 例（58%）一般包括死亡原因的数据。根据 ICD-MM，直接、间接和不明原因导致的死亡分别占 69.9%、20.6%和 5.2%，在一些研究中，4.3%的原因不明确。直接和间接导致死亡的主要原因分别是出血（30.7%）和高血压疾病（17.1%）以及循环系统疾病（8.1%）。在原始研究中，许多因素，包括生育次数、分娩类型、母亲的社会经济状况、分娩地点、死亡地点和产妇保健场所，被认为是伊朗孕产妇死亡的最重要决定因素。
结论
本研究提供了伊朗孕产妇死亡原因和决定因素的最新综合证据，这对于制定干预措施、降低孕产妇死亡率和发病率至关重要。
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