Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil.
Department of Statistics, Faculdade de Medicina de Jundiai, Jundiai, Brazil.
BMJ Open. 2020 Dec 10;10(12):e041138. doi: 10.1136/bmjopen-2020-041138.
To perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children.
A retrospective cohort study.
A tertiary maternity hospital from the southeast region of Brazil.
The exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth.
Validated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview.
All instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold).
SMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.
对经历严重产妇发病率（SMM）的妇女进行多维评估，以及其对妇女及其子女生活和健康的短期和中期影响。
回顾性队列研究。
巴西东南部一家三级妇产医院。
如果出现任何 SMM 诊断标准，则从重症监护病房入院的人群中选择暴露人群。对照组随机选择在同一产科和分娩时间内没有 SMM 的妇女。
通过电话应用经过验证的工具，评估创伤后应激障碍（PTSD）和生活质量（SF-36），然后通过面对面访谈评估一般和生殖健康、功能（WHO 残疾评估表）、性功能（女性性功能指数（FSFI））、儿童物质滥用（酒精、吸烟和物质参与筛查测试 2.0）和生长/发育（丹佛发育筛查测试）。在指数妊娠中出生的儿童。
所有仪器均应用于 638 名妇女（315 名患有 SMM；323 名对照组，分别评估了 264 名和 307 名儿童）。SMM 组的 SF-36 评分明显较低，而两组 PTSD 评分相似。患有 SMM 的妇女更容易不育，在指数妊娠后出现更多的临床异常情况，功能改变评分更高，而 FSFI 评分或任何药物使用的比例在两组之间相似。此外，SMM 组的儿童更有可能出现体重（三倍）和身高（1.5 倍）发育迟缓，并且发育受损（1.5 倍）。
SMM 损害了妇女及其子女生活的某些方面。重点应放在监测这些妇女及其子女产后的情况上，确保获得卫生服务，并减少对身体、生殖和心理社会健康的短期和中期影响。
