Schmidt Alexandra, Bachmann Gloria
Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.
Women's Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Womens Health Rep (New Rochelle). 2021 Mar 9;2(1):37-43. doi: 10.1089/whr.2021.0001. eCollection 2021.
The United States ranks poorly when compared with other developed nations with regard to its maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. Meanwhile, Finland consistently ranks as one of the safest places to be pregnant and give birth. The U.S. MMR more than doubled between 1987 and 2016, increasing from 7.2 deaths per 100,000 to 16.9, and has continued to increase. The Finnish MMR in 2017 was reported as 3 deaths per 100,000 live births, compared with the United States' 19 deaths for that same year. This article provides a comprehensive outline of Finland's structure of perinatal care, as well as a review of statistics concerning trends in the country's mortality and morbidity risk factors and a comparison with similar parameters in the United States. The Finnish maternal healthcare system was observed through the shadowing of healthcare providers during various pre- and postpartum patient encounters. Further discussion was supplemented by literature review. Although trends among Finnish mothers for more than the past 30 years indicate increased prevalence of mortality and morbidity risk factors, including C-section rates, maternal mortality remains consistently low. Observational data depict the Finnish perinatal care system as a decentralized community-based network of primary health facilities that emphasizes both physical and psychosocial well-being in the care of its expectant mothers. We suggest that the Finnish perinatal system of care may provide a good template from which the United States can model future efforts to decrease maternal mortality.
与其他发达国家相比,美国的孕产妇死亡率(MMR,定义为每10万例活产中的孕产妇死亡人数)排名很低。与此同时,芬兰一直是怀孕和分娩最安全的地方之一。1987年至2016年间,美国的孕产妇死亡率增加了一倍多,从每10万例中的7.2例死亡增至16.9例,并且仍在继续上升。2017年芬兰的孕产妇死亡率报告为每10万例活产中有3例死亡,而美国同年为19例。本文全面概述了芬兰的围产期护理结构,回顾了该国死亡率和发病风险因素趋势的统计数据,并与美国的类似参数进行了比较。通过在产前和产后不同患者就诊期间对医疗服务提供者的跟踪观察,对芬兰的孕产妇医疗系统进行了观察。进一步的讨论通过文献综述得到补充。尽管过去30多年来芬兰母亲中死亡率和发病风险因素的患病率呈上升趋势,包括剖宫产率,但孕产妇死亡率一直保持在较低水平。观察数据将芬兰的围产期护理系统描述为一个以社区为基础的分散的初级卫生设施网络,该网络在照顾准妈妈时既强调身体又强调心理社会福祉。我们认为,芬兰的围产期护理系统可能为美国未来降低孕产妇死亡率的努力提供一个很好的模板。