Hollenbach Stefanie J, Drennan Kathryn, Pressman Eva K, Gray Lisa
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
Obstet Gynecol. 2021 May 1;137(5):772-778. doi: 10.1097/AOG.0000000000004317.
To use a data-fusion approach to improve ascertainment of maternal deaths not detected with standard surveillance strategies.
We conducted a retrospective cohort study from the electronic health records of a tertiary medical center from 2011 to 2018. Cases of maternal death were identified in two ways: 1) using a standard medical informatics service query of hospital data and 2) using the TriNetX discovery tool as patients with a vital status of "deceased" and evidence of antecedent pregnancy exposure based on such factors as obstetric diagnostic codes or obstetric-related procedures. Potential cases of maternal death identified by the latter method underwent chart review to confirm timing of death compared with timing of last appreciable pregnancy, and to characterize the details of these deaths. The primary outcome was pregnancy-associated mortality during pregnancy or within the first postpartum year in the discovery cohort compared with the hospital-identified cohort. Secondary outcomes included causes of death and comorbidities.
During the study period, the standard service query identified 23 maternal deaths. The discovery tool identified 18 additional patients confirmed on subsequent chart review to represent pregnancy-associated deaths, a 78% increase in ascertainment of which a greater proportion represented postpartum deaths. The majority (61%) of newly ascertained mortalities were related to cardiac causes or other medical comorbidities. Although many hospital-ascertained cases were associated with deaths after delivery of a living newborn, more deaths after early pregnancy loss or termination were identified through the discovery tool.
Improved recognition of pregnancy-associated deaths can be achieved with modern data analytics.
采用数据融合方法，以改进对标准监测策略未检测到的孕产妇死亡情况的确定。
我们对一家三级医疗中心2011年至2018年的电子健康记录进行了一项回顾性队列研究。孕产妇死亡病例通过两种方式确定：1）使用医院数据的标准医学信息服务查询；2）使用TriNetX发现工具，将生命状态为“已故”且有基于产科诊断代码或产科相关程序等因素的既往妊娠暴露证据的患者作为孕产妇死亡病例。通过后一种方法确定的孕产妇死亡潜在病例进行病历审查，以确认死亡时间与最后一次可确认妊娠时间的比较，并描述这些死亡的详细情况。主要结局是发现队列与医院确定队列相比，妊娠期间或产后第一年内的妊娠相关死亡率。次要结局包括死亡原因和合并症。
在研究期间，标准服务查询确定了23例孕产妇死亡。发现工具又确定了18例经后续病历审查确认代表妊娠相关死亡的患者，确定率增加了78%，其中更大比例为产后死亡。新确定的死亡病例中，大多数（61%）与心脏原因或其他内科合并症有关。虽然许多医院确定的病例与活产新生儿出生后死亡有关，但通过发现工具确定了更多早期妊娠丢失或终止后死亡的病例。
现代数据分析可提高对妊娠相关死亡的识别。
