Kaskun Oleksandra, Greene Richard
Department of Obstetrics and Gynaecology, Cork University Hospital, Cork, IRL.
Cureus. 2022 Oct 4;14(10):e29901. doi: 10.7759/cureus.29901. eCollection 2022 Oct.
With declining maternal mortality rates in high-income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs. The objectives are to compare definitions and criteria used to identify SMM and identify the main causes and risk factors contributing to SMM in HICs. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched for articles published between 2010 and 2022, results were filtered, and 10 studies were critically appraised. Six of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stays and admission to the intensive care unit (ICU) were suggested as additional criteria. Disease-based criteria were shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe hemorrhage, hypertensive disorders, and preeclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and cesarean delivery were the most common. This literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several causes and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and 10 studies. Further research should aim to investigate how these criteria compare with previous sources of criteria and discern the association of weight and race risk factors with SMM.
随着高收入国家孕产妇死亡率的下降,严重孕产妇发病(SMM)正成为孕产妇护理的一项重要质量指标。然而,对于SMM的定义和类型尚无国际共识。本研究旨在对高收入国家已发表的关于SMM的文献进行批判性分析。目标是比较用于识别SMM的定义和标准,并确定高收入国家导致SMM的主要原因和风险因素。在PubMed、护理及联合健康文献累积索引(CINAHL)和Scopus数据库中检索了2010年至2022年发表的文章,对结果进行了筛选,并对10项研究进行了批判性评价。其中6篇文章讨论了SMM识别标准并提出了定义修改建议。建议将更长的住院时间和入住重症监护病房(ICU)作为附加标准。基于疾病的标准被证明优于器官功能障碍标准。7篇文章详细阐述了SMM的常见类型,如严重出血、高血压疾病和子痫前期/子痫。6篇文章描述了SMM的风险因素,其中高龄孕产妇和剖宫产最为常见。这篇文献综述确定基于疾病的标准和加拿大研究标准是有前景的SMM衡量指标。它还确定了高收入国家之间SMM的几个常见原因和风险因素。这些发现有助于医生识别有SMM风险的女性。然而,该研究仅限于8个高收入国家和10项研究。进一步的研究应旨在调查这些标准与以前的标准来源相比如何,并辨别体重和种族风险因素与SMM的关联。