Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.
Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
Acta Obstet Gynecol Scand. 2022 Apr;101(4):450-460. doi: 10.1111/aogs.14321. Epub 2022 Mar 2.
Obstetric hemorrhage-related deaths are rare in high income countries. Yet, with increasing incidences of obstetric hemorrhage in these countries, it is of utmost importance to learn lessons from each obstetric hemorrhage-related death to improve maternity care. Our objective was to calculate the obstetric hemorrhage-related maternal mortality ratio (MMR), assess causes of obstetric hemorrhage-related deaths, and identify lessons learned.
Nationwide mixed-methods prospective case-series with confidential enquiries into maternal deaths due to obstetric hemorrhage in the Netherlands from January 1, 2006 to December 31, 2019.
The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 was 0.7 per 100 000 livebirths and was not statistically significantly different compared with the previous MMR of 1.0 per 100 000 livebirths in 1993-2005 (odds ratio 0.70, 95% confidence interval 0.38-1.30). Leading underlying cause of hemorrhage was retained placenta. Early recognition of persistent bleeding, prompt involvement of a senior clinician and timely management tailored to the cause of hemorrhage with attention to coagulopathy were prominent lessons learned. Also, timely recourse to surgical interventions, including hysterectomy, in case other management options fail to stop bleeding came up as an important lesson in several obstetric hemorrhage-related deaths.
The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 has not substantially changed compared to the MMR of the previous enquiry in 1993-2005. Although obstetric hemorrhage is commonly encountered by maternity care professionals, it is important to remain vigilant for possible adverse maternal outcomes and act upon an ongoing bleeding following birth in a more timely and adequate manner. Our confidential enquiries still led to important lessons learned with clinical advice to professionals as how to improve maternity care and avoid maternal deaths. Drawing lessons from maternal deaths should remain a qualitative and moral imperative.
在高收入国家，与产科出血相关的产妇死亡较为罕见。然而，随着这些国家产科出血发生率的增加，从每一例与产科出血相关的死亡中吸取教训以改善产科护理至关重要。我们的目的是计算与产科出血相关的产妇死亡率（MMR），评估与产科出血相关的死亡原因，并确定从中吸取的经验教训。
对 2006 年 1 月 1 日至 2019 年 12 月 31 日期间荷兰因产科出血导致的产妇死亡进行全国范围内的混合方法前瞻性病例系列研究，对每例死亡进行保密调查。
2006-2019 年，荷兰与产科出血相关的 MMR 为每 10 万活产 0.7 例，与 1993-2005 年的前一次 MMR（每 10 万活产 1.0 例）相比无统计学显著差异（比值比 0.70，95%置信区间 0.38-1.30）。出血的主要潜在原因是胎盘滞留。突出的经验教训包括早期识别持续出血、及时让资深临床医生参与以及根据出血原因及时进行有针对性的管理，并注意凝血功能障碍；在其他治疗方法无法止血的情况下，及时采取手术干预措施，包括子宫切除术，在几例与产科出血相关的死亡中也被认为是一个重要的经验教训。
与 1993-2005 年的前一次调查相比，2006-2019 年荷兰与产科出血相关的 MMR 没有实质性变化。尽管产科出血是产科医护人员常见的情况，但重要的是要保持警惕，对分娩后持续出血的产妇可能出现的不良结局及时采取措施，并更加及时、充分地采取行动。我们的保密调查仍然为专业人员提供了重要的经验教训和临床建议，以改善产科护理并避免产妇死亡。从产妇死亡中吸取教训仍然是一个定性和道德上的必要条件。
