Tura Abera Kenay, Scherjon Sicco, Stekelenburg Jelle, van Roosmalen Jos, van den Akker Thomas, Zwart Joost
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Int J Womens Health. 2020 Apr 8;12:255-263. doi: 10.2147/IJWH.S240355. eCollection 2020.
To assess life-threatening complications among women admitted with severe hypertensive disorders of pregnancy and compare applicability of World Health Organization (WHO) maternal near-miss (MNM) criteria and the recently adapted sub-Saharan African (SSA) MNM criteria in eastern Ethiopia.
Of 1,054 women admitted with potentially life-threatening conditions between January 2016 and April 2017, 562 (53.3%) had severe preeclampsia/eclampsia. We applied the definition of MNM according to the WHO MNM criteria and the SSA MNM criteria. Logistic regression was performed to identify factors associated with severe maternal outcomes (MNMs and maternal deaths).
The SSA MNM criteria identified 285 cases of severe maternal outcomes: 271 MNMs and 14 maternal deaths (mortality index 4.9%). The WHO criteria identified 50 cases of severe maternal outcomes: 36 MNMs and 14 maternal deaths (mortality index 28%). The MNM ratio was 36.6 per 1,000 livebirths according to the SSA MNM criteria and 4.9 according to the WHO criteria. More than 80% of women in both groups had MNM events on arrival or within 12 hours after admission. Women without antenatal care, from rural areas, referred from other facilities, and with concomitant hemorrhage more often developed severe maternal outcomes.
Regarding hypertensive disorders of pregnancy, the SSA tool is more inclusive than the WHO tool, while still maintaining a considerably high mortality index indicating severity of included cases. This may enable more robust audits. Strengthening the referral system and improving prevention and management of obstetric hemorrhage in women with hypertensive disorders of pregnancy are required to avert severe maternal outcomes.
评估因妊娠高血压疾病住院的女性中危及生命的并发症，并比较世界卫生组织（WHO）孕产妇近危（MNM）标准和最近修订的撒哈拉以南非洲（SSA）MNM标准在埃塞俄比亚东部的适用性。
在2016年1月至2017年4月期间收治的1054名有潜在生命危险疾病的女性中，562名（53.3%）患有重度子痫前期/子痫。我们根据WHO MNM标准和SSA MNM标准应用MNM的定义。进行逻辑回归以确定与严重孕产妇结局（MNM和孕产妇死亡）相关的因素。
SSA MNM标准识别出285例严重孕产妇结局：271例MNM和14例孕产妇死亡（死亡率指数4.9%）。WHO标准识别出50例严重孕产妇结局：36例MNM和14例孕产妇死亡（死亡率指数28%）。根据SSA MNM标准，MNM比率为每1000例活产36.6例，根据WHO标准为4.9例。两组中超过80%的女性在入院时或入院后12小时内发生MNM事件。未接受产前检查、来自农村地区、从其他机构转诊以及伴有出血的女性更常出现严重孕产妇结局。
对于妊娠高血压疾病，SSA工具比WHO工具更具包容性，同时仍保持相当高的死亡率指数，表明所纳入病例的严重性。这可能有助于进行更有力的审核。需要加强转诊系统，改善妊娠高血压疾病女性产科出血的预防和管理，以避免严重孕产妇结局。
