埃塞俄比亚东部私立医院产妇接近发病的决定因素：巢式病例对照研究。
Determinants of maternal near-miss in private hospitals in eastern Ethiopia: A nested case-control study.
机构信息
Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
出版信息
Womens Health (Lond). 2021 Jan-Dec;17:17455065211061949. doi: 10.1177/17455065211061949.
OBJECTIVE
Maternal near-miss refers to a woman who nearly died but survived complications in pregnancy, childbirth, or within 42 days of termination of pregnancy. The study of maternal near-miss has become essential for improving the quality of obstetric care. The objective of this study was to identify the determinants of maternal near-miss among women admitted to major private hospitals in eastern Ethiopia.
METHOD
An unmatched nested case-control study was conducted in major private hospitals in eastern Ethiopia from 5 March to 31 March 2020. Cases were women who fulfilled the sub-Saharan African maternal near-miss criteria and those admitted to the same hospitals but discharged without any complications under the sub-Saharan African maternal near-miss tool were controls. For each case, three corresponding women were randomly selected as controls. Factors associated with maternal near-misses were analyzed using binary and multiple logistic regressions with an adjusted odds ratio along with a 95% confidence interval. Finally, p-value < 0.05 was considered as a cut-off point for the significant association.
RESULTS
A total of 432 women (108 cases and 324 controls) participated in the study. History of prior cesarean section (AOR = 4.33; 95% CI = 2.36-7.94), anemia in index pregnancy (AOR = 4.38; 95% CI = 2.43-7.91), being ⩾ 35 years of age (AOR = 2.94; 95% CI = 1.37-6.24), not attending antenatal care (AOR = 3.11; 95% CI = 1.43-6.78), and history of chronic medical disorders (AOR = 2.18; 95% CI = 1.03-4.59) were independently associated with maternal near-miss.
CONCLUSION
Maternal age ⩾ 35 years, had no antenatal care, had prior cesarean section, being anemic in index pregnancy, and have history of chronic medical disorders were the determinants of maternal near-miss. Improving maternal near-misses requires strengthening antenatal care (including supplementation of iron and folic acid to reduce anemia) and prioritizing women with a history of chronic medical illnesses. Interventions for preventing primary cesarean sections are crucial in this era of the cesarean epidemic to minimize its effect on maternal near-miss.
目的
孕产妇near-miss 是指因妊娠、分娩或妊娠终止后 42 天内的并发症而险些死亡但幸存下来的妇女。孕产妇 near-miss 的研究对于提高产科护理质量至关重要。本研究的目的是确定在埃塞俄比亚东部主要私立医院住院的妇女发生孕产妇 near-miss 的决定因素。
方法
2020 年 3 月 5 日至 3 月 31 日，在埃塞俄比亚东部主要私立医院进行了一项非匹配嵌套病例对照研究。病例是符合撒哈拉以南非洲孕产妇 near-miss 标准并在同一医院住院但无任何并发症出院的妇女，而那些符合撒哈拉以南非洲孕产妇 near-miss 工具标准的妇女则为对照组。对于每个病例，随机选择 3 名相应的妇女作为对照。采用二项和多因素逻辑回归分析与调整后的优势比（OR）及 95%置信区间（CI），分析与孕产妇 near-miss 相关的因素。最后，p 值<0.05 被认为是显著关联的截止点。
结果
共有 432 名妇女（108 例病例和 324 例对照）参加了研究。既往剖宫产史（OR=4.33；95%CI=2.36-7.94）、妊娠期贫血（OR=4.38；95%CI=2.43-7.91）、年龄≥35 岁（OR=2.94；95%CI=1.37-6.24）、未接受产前检查（OR=3.11；95%CI=1.43-6.78）和慢性疾病史（OR=2.18；95%CI=1.03-4.59）与孕产妇 near-miss 独立相关。
结论
年龄≥35 岁、无产前检查、既往剖宫产史、妊娠期贫血和有慢性疾病史是孕产妇 near-miss 的决定因素。改善孕产妇 near-miss 需要加强产前检查（包括补充铁和叶酸以减少贫血）和优先考虑有慢性疾病史的妇女。在剖宫产流行的时代，预防初次剖宫产的干预措施对于最大限度地减少其对孕产妇 near-miss 的影响至关重要。
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