Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
PLoS One. 2020 May 29;15(5):e0233697. doi: 10.1371/journal.pone.0233697. eCollection 2020.
There is international interest in monitoring severe events in the obstetrical population, commonly referred to as maternal near miss or severe maternal morbidity. These events can have significant consequences for individuals in this population and further study can inform practices to reduce both maternal morbidity and mortality. Numerous surveillance systems exist but we lack a standardized approach. Given the current inconsistencies and the importance in monitoring these events, this study aimed to identify and compare commonly used surveillance methods. In June 2018, we systematically searched MEDLINE, EMBASE, and CINAHL using terms related to monitoring/surveillance and maternal near miss/severe maternal morbidity. We included papers that used at least three indicators to monitor for these events and collected data on specific surveillance methods. We calculated the rate of maternal near miss/severe maternal morbidity in hospitalization data obtained from the 2016 US National Inpatient Sample using five common surveillance methods. Of 18,832 abstracts, 178 papers were included in our review. 198 indicators were used in studies included in our review; 71.2% (n = 141) of these were used in <10% of included studies and only 6.1% (n = 12) were used in >50% of studies included in our review. Eclampsia was the only indicator that was assessed in >80% of included studies. The rate of these events in American hospitalization data varied depending on the criteria used, ranging from 5.07% (95% CI = 5.02, 5.11) with the Centers for Disease Control criteria and 7.85% (95% CI = 7.79, 7.91) using the Canadian Perinatal Surveillance System. Our review highlights inconsistencies in monitoring practices within and between developed and developing countries. Given the wide variation in monitoring approaches observed and the likely contributing factors for these differences, it may be more feasible for clinical and academic efforts to focus on standardizing approaches in developed and developing countries independently at this time. PROSPERO Registration: CRD42018096858.
国际上对监测产科人群中的严重事件（通常称为孕产妇接近死亡或严重产妇发病率）感兴趣。这些事件可能对该人群中的个体产生重大影响，进一步的研究可以为减少产妇发病率和死亡率提供信息。存在许多监测系统，但我们缺乏标准化的方法。鉴于目前的不一致性以及监测这些事件的重要性，本研究旨在确定和比较常用的监测方法。
2018 年 6 月，我们使用与监测/监测和孕产妇接近死亡/严重产妇发病率相关的术语，系统地在 MEDLINE、EMBASE 和 CINAHL 中进行了搜索。我们纳入了至少使用三种指标来监测这些事件并收集特定监测方法数据的论文。我们使用五种常用的监测方法，从 2016 年美国国家住院患者样本中获得的住院数据计算孕产妇接近死亡/严重产妇发病率。在 18832 篇摘要中，有 178 篇论文被纳入我们的综述。我们综述中包括的研究使用了 198 个指标；其中 71.2%（n=141）在纳入研究中使用不到 10%，只有 6.1%（n=12）在纳入我们综述的研究中使用超过 50%。子痫是唯一在超过 80%的纳入研究中评估的指标。这些事件在美国住院数据中的发生率因使用的标准而异，范围从使用疾病控制中心标准的 5.07%（95%CI=5.02，5.11）到使用加拿大围产期监测系统的 7.85%（95%CI=7.79，7.91）。
我们的综述强调了发达国家和发展中国家监测实践中的不一致性。鉴于观察到监测方法的广泛差异以及这些差异的可能促成因素，目前临床和学术工作可能更可行的是，在发达国家和发展中国家独立地专注于标准化方法。PROSPERO 注册：CRD42018096858。
