尼日利亚西南部一家三级医院产妇入院 120 小时内院内死亡的预测因素和原因：一项回顾性队列研究。

Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study.

机构信息

Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria.

Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa.

出版信息

Niger Postgrad Med J. 2022 Oct-Dec;29(4):325-333. doi: 10.4103/npmj.npmj_180_22.

DOI:10.4103/npmj.npmj_180_22

PMID:36308262

Abstract

BACKGROUND

An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered.

AIM

This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria.

METHODS

We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis.

RESULTS

Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h.

CONCLUSION

The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.

摘要

背景

高效、全面的紧急产科护理（CEMOC）可以显著减轻尼日利亚产妇死亡率（MM）的负担。产妇入院 120 小时内死亡的风险信息可以反映所提供的 CEMOC 的质量。

目的

本研究旨在确定在尼日利亚拉各斯大学教学医院（LUTH），拉各斯西南部，产妇入院 120 小时内死亡的预测因素和原因。

方法

我们对 2007 年 1 月 1 日至 2017 年 12 月 31 日期间在尼日利亚西南部一家医院连续发生的产妇死亡进行了回顾性队列研究，使用患者病历中的数据。我们将在 120 小时内死亡的参与者与在 120 小时后存活的参与者进行了比较。生存寿命表分析、Kaplan-Meier 图和多变量 Cox 比例风险回归用于评估影响入院 120 小时内生存的因素。使用 Stata 版本 16 统计软件（StatCorp USA）进行分析。

结果

在 430 例产妇死亡中，有 326 例有完整记录。死亡患者的平均年龄为 30.7±（5.9）岁，中位死亡时间为 24（5-96）小时。326 例死亡患者中有 268 例（82.2%）在入院后 120 小时内死亡。几乎所有因子宫破裂（95.2%）和大部分因产科出血（87.3%）、人工流产（88.9%）、败血症（82.9%）和妊娠高血压疾病（77.9%）导致的产妇死亡均发生在入院后 120 小时内。入住重症监护病房（P = 0.007）、主治医生级别（P < 0.001）、死因（P = 0.036）和分娩方式（P = 0.012）是入院后 120 小时内死亡风险的独立预测因素。