Prüst Zita D, Kodan Lachmi R, van den Akker Thomas, Bloemenkamp Kitty W M, Rijken Marcus J, Verschueren Kim J C
Division of Women and Baby, Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands (Drs Prüst, Kodan, Bloemenkamp, Rijken, and Verschueren).
Department of Obstetrics and Gynecology, Academic Hospital Paramaribo, Paramaribo, Suriname (Dr Kodan).
AJOG Glob Rep. 2021 Oct 7;1(4):100027. doi: 10.1016/j.xagr.2021.100027. eCollection 2021 Nov.
Latin America and the Caribbean is the region with the highest prevalence of hypertensive disorders of pregnancy worldwide. In Suriname, where the stillbirth rate is the second highest in the region, it is not yet known which maternal factors contribute most substantially.
The aims of this study in Suriname were to (1) study the impact of different types of maternal morbidity on adverse perinatal outcomes and (2) study perinatal birth outcomes among women with severe hypertensive disorders of pregnancy.
A case-control study was conducted between March 2017 and February 2018 during which time all hospital births (86% of total) in Suriname were included. We identified babies with adverse perinatal outcomes (perinatal death or neonatal near miss) and women with severe maternal morbidity (according to the World Health Organization Near Miss tool). Stillbirths and early neonatal deaths (<7 days) were considered perinatal death. We defined a neonatal near miss as a birthweight below 1750 g, gestational age <33 weeks, 5-minute Apgar score <7, and preterm intrauterine growth restriction <p3. Descriptive statistics and multivariate binary logistic regression analyses were conducted.
In the 1-year study period, adverse perinatal outcomes were reported for 638 singleton births of which 120 (18.8%) involved women with severe maternal morbidity. In most of these cases, the mother suffered severe hypertensive disorders of pregnancy (n=95/120, 79.2%). Severe hypertensive disorders of pregnancy were strongly associated with adverse perinatal outcomes (adjusted odds ratio, 11.1; 95% confidence interval, 8.3-14.9). The prevalence of severe hypertensive disorders of pregnancy in Suriname was 2.5% (234/9197). Of the 215 singleton pregnancies complicated by severe hypertensive disorders, adverse perinatal outcomes were reported for 44.2% of them (n=95/215; adjusted odds ratio, 11.1; 95% confidence interval, 8.3-14.9); perinatal death accounted for 18.1% of these cases (n=39/215; adjusted odds ratio, 8.6; 95% confidence interval, 5.8-12.7) and neonatal near miss accounted for another 26.0% (n=56/215). Women with severe hypertensive disorders of pregnancy had a preterm birth (<37 weeks) in 67.1% of the cases (n=143/215; adjusted odds ratio, 14.1; 95% confidence interval, 10.5-19.0), a baby with a low birthweight (<2500 g) in 62.2% of the cases (n=130/215; adjusted odds ratio, 10.8; 95% confidence interval, 8.1-14.5), and a baby with a low 5-minute Apgar score in 20.5% of the cases (n=43/215; adjusted odds ratio, 6.9; 95% confidence interval, 4.8-10.0).
In Suriname, severe hypertensive disorders of pregnancy are strongly associated with adverse perinatal outcomes, with an increased risk for preterm birth, low birthweight, low Apgar score, and perinatal mortality. Prevention, early diagnosis, and management of hypertensive disorders of pregnancy are expected to reduce perinatal deaths substantially. Recommendations to reduce perinatal deaths in Suriname include the establishment of a national health plan for the management of severe hypertensive disorders of pregnancy and the introduction of perinatal death and neonatal near miss reviews.
拉丁美洲和加勒比地区是全球妊娠高血压疾病患病率最高的地区。在该地区死产率第二高的苏里南，尚不清楚哪些孕产妇因素的影响最为显著。
本项在苏里南开展的研究旨在：（1）研究不同类型的孕产妇发病情况对围产期不良结局的影响；（2）研究患有严重妊娠高血压疾病的女性的围产期出生结局。
于2017年3月至2018年2月开展了一项病例对照研究，在此期间纳入了苏里南所有的医院分娩病例（占总数的86%）。我们确定了围产期不良结局的婴儿（围产期死亡或新生儿濒临死亡）以及患有严重孕产妇疾病的女性（根据世界卫生组织的濒临死亡工具）。死产和早期新生儿死亡（<7天）被视为围产期死亡。我们将新生儿濒临死亡定义为出生体重低于1750g、孕周<33周、5分钟阿氏评分<7以及早产宫内生长受限<p3。进行了描述性统计和多变量二元逻辑回归分析。
在为期1年的研究期间，638例单胎分娩报告了围产期不良结局，其中120例（18.8%）涉及患有严重孕产妇疾病的女性。在大多数此类病例中，母亲患有严重的妊娠高血压疾病（n=95/120，79.2%）。严重的妊娠高血压疾病与围产期不良结局密切相关（调整后的优势比为11.1；95%置信区间为8.3-14.9）。苏里南严重妊娠高血压疾病的患病率为2.5%（234/9197）。在215例并发严重妊娠高血压疾病的单胎妊娠中，44.2%报告了围产期不良结局（n=95/215；调整后的优势比为11.1；95%置信区间为8.3-14.9）；围产期死亡占这些病例的18.
