孕产妇因子宫破裂导致的接近死亡和死亡：尼日利亚接近死亡和孕产妇死亡调查的二次分析。
Maternal near-miss and death among women with rupture of the gravid uterus: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.
机构信息
Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria.
Department of Obstetrics and Gynaecology, University of Uyo Teaching Hospital, Uyo, Nigeria.
出版信息
BJOG. 2019 Jun;126 Suppl 3:26-32. doi: 10.1111/1471-0528.15700. Epub 2019 May 3.
OBJECTIVE
To investigate the burden of maternal near-miss and death due to rupture of the gravid uterus, the indicators of quality of care, and avoidable factors associated with care deficiencies for ruptured uterus in Nigerian tertiary hospitals.
DESIGN
Secondary analysis of a nationwide cross-sectional study.
SETTING
Forty-two tertiary hospitals.
POPULATION
Women admitted for pregnancy, childbirth or puerperal complications.
METHODS
Cases of severe maternal outcome [SMO: maternal near-miss (MNM) or maternal death (MD)] following uterine rupture were prospectively identified over 1 year.
MAIN OUTCOME MEASURES
Incidence of SMO, indicators of quality of care, and avoidable factors associated with deficiencies in care.
RESULTS
There were 91 724 live births and 3285 women with SMO during the study period. SMO due to uterine rupture occurred in 392 women: 305 MNM and 87 MD. Uterine rupture accounted for 11.9, 13.3, and 8.7% of all SMO, MNM, and MD, respectively. SMO, MNM, and intra-hospital maternal mortality ratios due to uterine rupture were 4.3/1000 live births, 3.3/1000 live births, and 94.8/100 000 live births, respectively. Mortality index (% of MD/SMO) was 22.2%, and MNM:MD ratio was 3.5. Avoidable factors contributing to deaths were related to patient-orientated problems, especially late hospital presentation and lack of insurance to cover life-saving interventions. Medical personnel problems contributed to care deficiencies in one-third of women who died.
CONCLUSION
Uterine rupture significantly contributes to SMO in Nigerian tertiary hospitals. Strategies to improve maternal survival should address avoidable institutional factors and include community-based interventions to encourage skilled attendance at birth and early referral of complications.
TWEETABLE ABSTRACT
Uterine rupture remains an important cause of maternal death in Nigerian tertiary hospitals.
目的
调查因妊娠子宫破裂导致的孕产妇死亡和接近死亡病例的负担，以及尼日利亚三级医院在处理破裂子宫方面存在的与护理不足相关的可避免因素和护理质量指标。
设计
全国性横断面研究的二次分析。
地点
42 家三级医院。
人群
因妊娠、分娩或产褥期并发症而住院的女性。
方法
在 1 年期间，前瞻性地确定严重孕产妇结局病例（SMO：孕产妇接近死亡（MNM）或孕产妇死亡（MD））。
主要观察指标
SMO 的发生率、护理质量指标和与护理不足相关的可避免因素。
结果
研究期间共有 91724 例活产和 3285 例 SMO 患者。392 例患者因子宫破裂导致 SMO：205 例 MNM 和 87 例 MD。子宫破裂分别占所有 SMO、MNM 和 MD 的 11.9%、13.3%和 8.7%。子宫破裂导致的 SMO、MNM 和院内孕产妇死亡率分别为 4.3/1000 活产、3.3/1000 活产和 94.8/100000 活产。死亡率指数（MD/SMO 的%）为 22.2%，MNM:MD 比为 3.5。导致死亡的可避免因素与以患者为中心的问题有关，特别是就诊时间晚和缺乏支付救命干预措施的保险。三分之一的死亡患者的医护人员问题导致了护理不足。
结论
子宫破裂是尼日利亚三级医院 SMO 的重要原因。提高孕产妇生存的策略应解决可避免的机构因素，并包括以社区为基础的干预措施，以鼓励熟练的分娩和早期转诊并发症。
推特摘要
子宫破裂仍然是尼日利亚三级医院孕产妇死亡的一个重要原因。
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