Sachs B P, Brown D A, Driscoll S G, Schulman E, Acker D, Ransil B J, Jewett J F
Department of Obstetrics and Gynecology, Beth Israel Hospital, Boston, MA 02215.
Am J Public Health. 1988 Jun;78(6):671-5. doi: 10.2105/ajph.78.6.671.
Hemorrhage, infection, toxemia, and cardiac disease are no longer the leading causes of maternal death. We studied factors causing their decline in incidence using data collected by the Committee on Maternal Welfare of the Massachusetts Medical Society between 1954 and 1985. The dramatic decline in incidence of these conditions in the Commonwealth during the study period appears to have been due to both legislative actions and improvements in medical practice. The legislative actions included licensing of maternity services, blood banks, and legalization of abortion. Cardiac-related mortality has declined due to a reduction in the prevalence of rheumatic heart disease. Changes in clinical practice that stand out were the aggressive control of the hypertensive component of toxemia leading to a reduced incidence of intracranial hemorrhage, the prompt recourse to blood transfusion for hemorrhage, and the use of broad spectrum antibiotics.
出血、感染、毒血症和心脏病不再是孕产妇死亡的主要原因。我们利用马萨诸塞州医学协会孕产妇福利委员会在1954年至1985年期间收集的数据，研究了导致这些疾病发病率下降的因素。在研究期间，该州这些疾病发病率的显著下降似乎是由于立法行动和医疗实践的改善。立法行动包括对产科服务、血库进行许可，以及堕胎合法化。与心脏相关的死亡率下降是由于风湿性心脏病患病率的降低。突出的临床实践变化包括积极控制毒血症的高血压成分，从而降低颅内出血的发病率，对出血迅速采取输血措施，以及使用广谱抗生素。
