Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
Division of Maternal-Fetal Medicine, Vanderbilt University, Nashville, TN, USA.
BJOG. 2019 Sep;126(10):1223-1230. doi: 10.1111/1471-0528.15818. Epub 2019 Jun 20.
This study utilized the Dr. Foster Global Comparators database to identify pregnancy complications and associated risk factors that led to severe maternal morbidity during delivery hospitalisations in large university hospitals based in the USA, Australia, and England.
Retrospective cohort.
Births in the USA, England and Australia from 2008 to 2013.
Data from delivery hospitalisations between 2008 and 2013 were examined using the Dr. Foster Global Comparators database.
We identified delivery hospitalisations with life-threatening diagnoses or use of life-saving procedures, using algorithms for severe maternal morbidity from the Center for Disease Control. Frequency of severe maternal morbidity was calculated for each country.
Multivariable analysis was used to examine the association between morbidity and socio-demographic and clinical characteristics within each country. Chi-square tests assessed differences in covariates between countries.
From 2008 to 2013, there were 516 781 deliveries from a total of 18 hospitals: 24.5% from the USA, 57.0% from England and 18.4% from Australia. Overall severe maternal morbidity rate was 8.2 per 1000 deliveries: 15.6 in the USA, 5.0 in England, and 8.2 in Australia. The most common codes identifying severe morbidity included transfusion, disseminated intravascular coagulation, acute renal failure, cardiac events/procedures, ventilation, hysterectomy, and eclampsia. Advanced maternal age, hypertension, diabetes, and substance abuse were associated with severe maternal morbidity in all three countries.
Rates of severe maternal morbidity differed by country. Identification of geographical, socio-demographic, and clinical differences can help target modifications of practice and potentially reduce severe maternal morbidity.
Rates of severe maternal morbidity vary, but risk factors associated with adverse outcomes are similar in developed countries.
本研究利用福斯特博士全球对照数据库，在美国、澳大利亚和英国的大型大学附属医院中，确定导致分娩住院期间严重产妇发病率的妊娠并发症和相关危险因素。
回顾性队列研究。
2008 年至 2013 年在美国、英国和澳大利亚的分娩。
使用福斯特博士全球对照数据库，对 2008 年至 2013 年分娩住院的数据进行了检查。
我们使用疾病控制中心严重产妇发病率的算法，确定具有威胁生命的诊断或使用救生程序的分娩住院患者。为每个国家计算严重产妇发病率的频率。
在每个国家内，使用多变量分析来检查发病率与社会人口统计学和临床特征之间的关联。卡方检验评估了各国之间协变量的差异。
在 2008 年至 2013 年期间，来自 18 家医院的总共 516781 例分娩中，24.5%来自美国，57.0%来自英国，18.4%来自澳大利亚。总体严重产妇发病率为每 1000 例分娩 8.2 例：美国为 15.6，英国为 5.0，澳大利亚为 8.2。确定严重发病率的最常见代码包括输血、弥漫性血管内凝血、急性肾衰竭、心脏事件/程序、通气、子宫切除术和子痫。在所有三个国家中，高龄产妇、高血压、糖尿病和药物滥用与严重产妇发病率相关。
严重产妇发病率的国家之间存在差异。确定与不良结局相关的地理、社会人口统计学和临床差异有助于有针对性地修改实践，并可能降低严重产妇发病率。
严重产妇发病率存在差异，但与不良结局相关的危险因素在发达国家相似。
