Chaudhuri Snehamay, Nath Sumana
1Department of Obstetrics and Gynecology, NRS Medical College, 138 AJC Bose Road, Kolkata, West Bengal India.
2Present Address: Obstetrics and Gynecology, Midnapore Medical College, Midnapore, India.
J Obstet Gynaecol India. 2019 Apr;69(2):115-122. doi: 10.1007/s13224-018-1106-8. Epub 2018 Apr 2.
To test the application of a clinical definition of life-threatening complications in pregnancy and determine the level of near miss maternal morbidity and mortality.
A prospective observational study was conducted in the obstetrics and gynaecology department, NRS Medical College, Kolkata, India, to identify life-threatening complications using a modification of the Mantel's criteria. The main outcome measures were validity of identification criteria, main causes and incidence of life-threatening complications in pregnancy, maternal near miss: case fatality rates, morbidity-mortality index and use rate of effective interventions.
In total, 177 maternal near miss and 23 maternal deaths were identified in the screened 4400 women. The incidence of near miss was 4.02%. Main causes of maternal mortality were hypertensive disorders (43%) and renal failure (21%). Main causes of near miss were hypertensive disorders (55%), ectopic pregnancy (19%). Near miss mortality index was 7.7:1.
A high proportion of women with life-threatening complications and all women who died were referred from peripheral hospitals. This signals that there may have been important failures in the referral system relating to maternal care and there is a need for further investigation.
测试妊娠危及生命并发症临床定义的应用情况，并确定孕产妇近死亡发病率和死亡率水平。
在印度加尔各答NRS医学院妇产科进行了一项前瞻性观察研究，采用改良的曼特尔标准识别危及生命的并发症。主要结局指标为识别标准的有效性、妊娠危及生命并发症的主要原因和发生率、孕产妇近死亡：病死率、发病死亡率指数及有效干预措施的使用率。
在筛查的4400名女性中，共识别出177例孕产妇近死亡和23例孕产妇死亡。近死亡发生率为4.02%。孕产妇死亡的主要原因是高血压疾病（43%）和肾衰竭（21%）。近死亡的主要原因是高血压疾病（55%）、异位妊娠（19%）。近死亡死亡率指数为7.7:1。
很大一部分有危及生命并发症的女性以及所有死亡女性均来自周边医院。这表明在孕产妇护理转诊系统中可能存在重大失误，需要进一步调查。
