Deneux-Tharaux C, Saucedo M
Inserm U1153, CRESS, équipe EPOPé, épidémiologie obstétricale périnatale et pédiatrique, université de Paris, Inra, FHU PREMA, 53, avenue de l'Observatoire, 75014 Paris, France.
Inserm U1153, CRESS, équipe EPOPé, épidémiologie obstétricale périnatale et pédiatrique, université de Paris, Inra, FHU PREMA, 53, avenue de l'Observatoire, 75014 Paris, France.
Gynecol Obstet Fertil Senol. 2021 Jan;49(1):3-8. doi: 10.1016/j.gofs.2020.11.005. Epub 2020 Nov 13.
Maternal mortality, despite its rarity in rich countries, remains a fundamental indicator of maternal health. It is considered as a "sentinel event", consequence of dysfunctions of the health care system, often cumulative. In addition to the classical epidemiological surveillance outcomes-number of deaths, maternal mortality ratio and identification of the subgroups of women at higher risk-its study allows an accurate analysis of each deceased woman's trajectory to identify opportunities for improvements in the content or organization of care; the correction of which will make it possible to prevent deaths but also upstream morbid events affected by the same dysfunctions. To achieve this dual epidemiological and clinical audit objective, an ad hoc enhanced system is needed. France has had such a system since 1996, the National Confidential enquiry into maternal deaths (ENCMM), coordinated by the Inserm Epopé team. The methodology has been adapted over time to improve completeness and better document cases. The first step is the multi-source identification (direct declaration, death certificate, birth certificates, hospital discharge data) of women who died during pregnancy or within one year of its end, in metropolitan France and overseas departments. The second step is the collection of detailed information for each death by a pair of clinical assessors. Recent evolutions aim to better document the social context of women as well as the background of women who have died of suicide. Psychiatrists have been included among the assessors. The third stage is the review of these anonymized documents by the National Committee of Experts on Maternal Mortality, which judges whether the death is maternal (causal link) and makes a judgment on the adequacy of care and avoidability of death. A psychiatrist is now associated to the CNEMM for the assessment of maternal suicides. The synthesis of the information thus collected for maternal deaths in the period 2013-2015 is presented in these articles of this special issue.
孕产妇死亡尽管在富裕国家较为罕见，但仍是孕产妇健康的一项基本指标。它被视为一种“标志性事件”，是医疗保健系统功能失调的后果，且往往具有累积性。除了经典的流行病学监测结果（死亡人数、孕产妇死亡率以及识别高危女性亚组）之外，对孕产妇死亡的研究还能精确分析每位死亡女性的就医过程，以确定在医疗服务内容或组织方面进行改进的机会；纠正这些问题不仅能够预防死亡，还能预防受相同功能失调影响的上游发病事件。为实现这一双重的流行病学和临床审计目标，需要一个专门的强化系统。自1996年以来，法国就有这样一个系统，即由法国国家医学与健康研究院（Inserm）的Epopé团队协调开展的全国孕产妇死亡保密调查（ENCMM）。随着时间的推移，该方法不断调整，以提高完整性并更好地记录案例。第一步是通过多渠道识别（直接申报、死亡证明、出生证明、医院出院数据）在法国本土及海外省孕期或产后一年内死亡的女性。第二步是由一对临床评估人员为每例死亡收集详细信息。最近的改进旨在更好地记录女性的社会背景以及自杀死亡女性的背景。评估人员中纳入了精神科医生。第三阶段是由国家孕产妇死亡专家委员会审查这些匿名文件，该委员会判断死亡是否与孕产妇相关（因果关系），并对医疗服务的充分性和死亡的可避免性做出判断。现在有一名精神科医生与国家孕产妇死亡专家委员会合作，对孕产妇自杀进行评估。本期特刊的这些文章介绍了2013 - 2015年期间收集的孕产妇死亡信息的综合情况。
