Dzakpasu Susie, Deb-Rinker Paromita, Arbour Laura, Darling Elizabeth K, Kramer Michael S, Liu Shiliang, Luo Wei, Murphy Phil A, Nelson Chantal, Ray Joel G, Scott Heather, VandenHof Michiel, Joseph K S
Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, ON.
Department of Medical Genetics, University of British Columbia, Victoria, BC.
J Obstet Gynaecol Can. 2019 Nov;41(11):1589-1598.e16. doi: 10.1016/j.jogc.2019.02.014. Epub 2019 May 3.
This study sought to quantify temporal trends and provincial and territorial variations in severe maternal morbidity (SMM) in Canada.
The study used data on all hospital deliveries in Canada (excluding Québec) from 2003 to 2016 to examine temporal trends and from 2012 to 2016 to study regional variations. SMM was identified using diagnosis and intervention codes. Contrasts among periods and regions were quantified using rate ratios (RRs) and 95% confidence intervals (CIs). Temporal changes were also assessed using chi-square tests for trend (Canadian Task Force Classification II-1).
The study population included 3 882 790 deliveries between 2003 and 2016 and 1 418 545 deliveries between 2012 and 2016. Severe hemorrhage rates increased from 44.8 in 2003 to 62.4 per 10 000 deliveries in 2012 (P for trend <0.0001) and then declined to 41.8 per 10 000 deliveries in 2016 (P for trend <0.0001). Maternal intensive care unit admission and sepsis rates decreased between 2003 and 2016, whereas rates of stroke, severe uterine rupture, hysterectomy, obstetric embolism, shock, and assisted ventilation increased. Rates of composite SMM in 2012-2016 were higher in Newfoundland and Labrador (RR 1.15; 95% CI 1.04-1.26), Nova Scotia (RR 1.11; 95% CI 1.03-1.19), New Brunswick (RR1.22; 95% CI 1.13-1.32), Manitoba (RR 1.09; 95% CI 1.03-1.15), Saskatchewan (RR 1.15; 95% CI 1.09-1.22), the Yukon (RR 1.74; 95% CI 1.35-2.25), and Nunavut (RR 1.76; 95% CI 1.46-2.11) compared with the rest of Canada, whereas rates were lower in Alberta and British Columbia.
This surveillance report helps inform clinical practice and public health policy for improving maternal health in Canada.
本研究旨在量化加拿大严重孕产妇发病情况（SMM）的时间趋势以及省和地区差异。
该研究使用了2003年至2016年加拿大（不包括魁北克）所有医院分娩的数据来研究时间趋势，以及2012年至2016年的数据来研究地区差异。通过诊断和干预代码来识别严重孕产妇发病情况。使用率比（RRs）和95%置信区间（CIs）对不同时期和地区之间的差异进行量化。还使用趋势卡方检验评估时间变化（加拿大工作组分类II-1）。
研究人群包括2003年至2016年期间的3882790例分娩以及2012年至2016年期间的1418545例分娩。严重出血率从2003年的每10000例分娩44.8例增加到2012年的每10000例分娩62.4例（趋势P<0.0001），然后在2016年降至每10000例分娩41.8例（趋势P<0.0001）。2003年至2016年期间，孕产妇重症监护病房收治率和败血症发生率下降，而中风、严重子宫破裂、子宫切除术、产科栓塞、休克和辅助通气的发生率上升。与加拿大其他地区相比，2012 - 2016年期间，纽芬兰和拉布拉多（RR 1.15；95% CI 1.04 - 1.26）、新斯科舍（RR 1.11；95% CI 1.03 - 1.19）、新不伦瑞克（RR1.22；95% CI 1.13 - 1.32）、马尼托巴（RR 1.09；95% CI 1.03 - 1.15）、萨斯喀彻温（RR 1.15；95% CI 1.09 - 1.22）、育空地区（RR 1.74；95% CI 1.35 - 2.25）和努纳武特地区（RR 1.76；95% CI 1.46 - 2.11）的综合严重孕产妇发病情况发生率较高，而艾伯塔省和不列颠哥伦比亚省的发生率较低。
本监测报告有助于为改善加拿大孕产妇健康的临床实践和公共卫生政策提供信息。
