Klinik für Geburtshilfe, Universitätsspital Zürich, Switzerland.
Swiss Med Wkly. 2020 Oct 5;150:w20345. doi: 10.4414/smw.2020.20345.
Maternal mortality is an important indicator for quality control in obstetrics. To improve clinical care, maternal mortality should be assessed periodically. In this study, we analysed maternal mortality cases between 2005 and 2014 in Switzerland and compared them with those in earlier periods.
The Federal Statistical Office (FSO) provided all death certificates between 2005 and 2014 with an ICD-10 code in the obstetric field (indicated with the letter O). Additionally, we included all death certificates that gave a positive answer about pregnancy or birth within the last 42 days. We also included cases where death occurred within 365 days after delivery. For an analysis of underreporting, cases from the Institute of Forensic Medicine (IRM), Zurich, were included. The cases were classified according to ICD-10 as “direct”, “indirect”, “non-pregnancy-related”, and “late” deaths. The direct maternal mortality rate (MMR), and indirect and combined MMRs were calculated.
We received 117 cases from the FSO, and one additional case was found in the archives of the IRM. Ninety-six cases were eligible for detailed evaluation. As 787,025 live births were recorded between 2005 and 2014 in Switzerland, the direct MMR was 3.30/100,000 live births (26 cases). It has decreased by 20.5% compared with the MMR in 1995–2004 (4.15/100,000 live births, 32 cases; p = n.s.) and by 40.4% compared with the MMR in 1985–1994 (5.54/100,000 live births, 45 cases; odds ratio [OR] 0.6, p = 0.04, 95% confidence interval [CI] 0.37–0.97). The leading cause for direct maternal mortality in the current study period was haemorrhage (nine cases), followed by amniotic fluid embolisms and preeclampsia (five cases each). The indirect MMR was 3.68/100,000 live births. In this group, 13 women committed suicide and 8 women died of complications of pre-existing cardiac pathologies. Suicide was the leading cause of maternal deaths, had suicides been classified as direct obstetric cases. The combined MMR (direct and indirect) was 6.61/100,000 live births (52 cases) (OR 4.8–8.4). Of 41 non-pregnancy-related cases, almost half (20 cases) died of cancer within the first year after delivery. Lethality after caesarean section was 0.008‰ (2/231,385).
The trend of reducing direct maternal mortality as well as lethality after caesarean section continues. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. Indirect maternal mortality is increasing and specifically suicides need special attention. Precise documentation of all maternal deaths is essential to improve outcomes for future mothers.
孕产妇死亡是产科质量控制的一个重要指标。为了改善临床护理，应定期评估孕产妇死亡率。在这项研究中，我们分析了 2005 年至 2014 年瑞士的孕产妇死亡病例，并与早期时期的病例进行了比较。
联邦统计局（FSO）提供了 2005 年至 2014 年期间所有带有产科领域 ICD-10 编码（用字母 O 表示）的死亡证明。此外，我们还包括了所有在过去 42 天内怀孕或分娩的死亡证明。我们还包括了在分娩后 365 天内死亡的病例。为了分析漏报情况，我们还包括了苏黎世法医研究所（IRM）的病例。根据 ICD-10，这些病例被分为“直接”、“间接”、“与妊娠无关”和“晚期”死亡。计算了直接孕产妇死亡率（MMR）、间接和综合 MMR。
我们从 FSO 收到了 117 例病例，在 IRM 的档案中还发现了另外 1 例。96 例符合详细评估条件。在 2005 年至 2014 年期间，瑞士有 787,025 例活产，直接 MMR 为每 100,000 例活产 3.30 例（26 例）。与 1995-2004 年 MMR（每 100,000 例活产 4.15 例，32 例；p=n.s.）相比，下降了 20.5%，与 1985-1994 年 MMR（每 100,000 例活产 5.54 例，45 例；比值比[OR]0.6，p=0.04，95%置信区间[CI]0.37-0.97）相比，下降了 40.4%。当前研究期间直接导致孕产妇死亡的主要原因是出血（9 例），其次是羊水栓塞和子痫前期（各 5 例）。间接 MMR 为每 100,000 例活产 3.68 例。在这一组中，有 13 名妇女自杀，8 名妇女死于先前存在的心脏疾病并发症。自杀是孕产妇死亡的主要原因，如果将自杀归类为直接产科病例。直接和间接的综合 MMR（直接和间接）为每 100,000 例活产 6.61 例（52 例）（OR 4.8-8.4）。在 41 例非妊娠相关病例中，近一半（20 例）在分娩后一年内死于癌症。剖宫产术后的致死率为 0.008%（2/231,385）。
降低直接孕产妇死亡率和剖宫产术后致死率的趋势仍在继续。出血仍然是导致直接孕产妇死亡的主要原因；这一比例与 90 年代初相似。间接孕产妇死亡率正在上升，特别是自杀需要特别关注。准确记录所有孕产妇死亡情况对于改善未来母亲的结局至关重要。
