Maternal, Child and Youth Health Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
Department of Medical Genetics, University of British Columbia, Victoria, BC, Canada.
Paediatr Perinat Epidemiol. 2020 Jul;34(4):427-439. doi: 10.1111/ppe.12574. Epub 2019 Aug 12.
There is no international consensus on the definition and components of severe maternal morbidity (SMM).
To propose a comprehensive definition of SMM, to create an empirically justified list of SMM types and subtypes, and to use this to examine SMM in Canada.
Severe maternal morbidity was defined as a set of heterogeneous maternal conditions known to be associated with severe illness and with prolonged hospitalisation or high case fatality. Candidate SMM types/subtypes were evaluated using information on all hospital deliveries in Canada (excluding Quebec), 2006-2015. SMM rates for 2012-2016 were quantified as a composite and as SMM types/subtypes. Rate ratios and population attributable fractions (PAF) associated with overall and specific SMM types/subtypes were estimated in relation to length of hospital stay (LOS > 7 days) and case fatality.
There were 22 799 cases of SMM subtypes (among 1 418 545 deliveries) that were associated with a prolonged LOS or high case fatality. Between 2012 and 2016, the composite SMM rate was 16.1 (95% confidence interval [CI] 15.9, 16.3) per 1000 deliveries. Severe pre-eclampsia and HELLP syndrome (514.6 per 100 000 deliveries), and severe postpartum haemorrhage (433.2 per 100 000 deliveries) were the most common SMM types, while case fatality rates among SMM subtypes were highest among women who had cardiac arrest and resuscitation (241.1 per 1000), hepatic failure (147.1 per 1000), dialysis (67.6 per 1000), and cerebrovascular accident/stroke (51.0 per 1000). The PAF for prolonged hospital stay related to SMM was 17.8% (95% CI 17.3, 18.3), while the PAF for maternal death associated with SMM was 88.0% (95% CI 74.6, 94.4).
The proposed definition of SMM and associated list of SMM subtypes could be used for standardised SMM surveillance, with rate ratios and PAFs associated with specific SMM types/subtypes serving to inform clinical practice and public health policy.
目前对于严重孕产妇并发症（SMM）的定义和组成部分尚无国际共识。
提出严重孕产妇并发症的综合定义，创建具有实证依据的严重孕产妇并发症类型和亚型清单，并使用该清单来研究加拿大的严重孕产妇并发症。
严重孕产妇并发症被定义为一组已知与严重疾病相关并伴有延长住院时间或高病死率的异质性孕产妇情况。使用 2006 年至 2015 年加拿大（魁北克除外）所有医院分娩的数据，对候选严重孕产妇并发症类型/亚型进行评估。2012 年至 2016 年的严重孕产妇并发症发生率被量化为综合发生率和严重孕产妇并发症类型/亚型发生率。根据住院时间延长（＞7 天）和病死率，估算与所有严重孕产妇并发症类型/亚型以及特定严重孕产妇并发症类型/亚型相关的率比和人群归因分数（PAF）。
在 1418545 例分娩中，有 22799 例发生严重孕产妇并发症亚型，与延长住院时间或高病死率相关。2012 年至 2016 年期间，严重孕产妇并发症的综合发生率为 16.1（95%置信区间 15.9，16.3）/1000 例分娩。严重子痫前期和 HELLP 综合征（514.6/100000 例分娩）和严重产后出血（433.2/100000 例分娩）是最常见的严重孕产妇并发症类型，而严重孕产妇并发症亚型的病死率在心脏骤停和复苏的产妇（241.1/1000）、肝衰竭（147.1/1000）、血液透析（67.6/1000）和脑血管意外/中风（51.0/1000）中最高。与严重孕产妇并发症相关的延长住院时间的人群归因分数为 17.8%（95%置信区间 17.3，18.3），而与严重孕产妇并发症相关的孕产妇死亡的人群归因分数为 88.0%（95%置信区间 74.6，94.4）。
所提出的严重孕产妇并发症定义和相关的严重孕产妇并发症亚型清单可用于标准化的严重孕产妇并发症监测，与特定严重孕产妇并发症类型/亚型相关的率比和人群归因分数可用于指导临床实践和公共卫生政策。
