Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2022 Nov 1;5(11):e2244077. doi: 10.1001/jamanetworkopen.2022.44077.
In the US, more than 50 000 women experience severe maternal morbidity (SMM) each year, and the SMM rate more than doubled during the past 25 years. In response, professional organizations called for birthing facilities to routinely identify and review SMM events and identify prevention opportunities.
To examine SMM levels, primary causes, and factors associated with the preventability of SMM using Maryland's SMM surveillance and review program.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included pregnant and postpartum patients at 42 days or less after delivery who were hospitalized at 1 of 6 birthing hospitals in Maryland between August 1, 2020, and November 30, 2021. Hospital-based SMM surveillance was conducted through a detailed review of medical records.
Hospitalization during pregnancy or within 42 days post partum.
The main outcomes were admission to an intensive care unit, having at least 4 U of red blood cells transfused, and/or having COVID-19 infection requiring inpatient hospital care.
A total of 192 SMM events were identified and reviewed. Patients with SMM had a mean [SD] age of 31 [6.49] years; 9 [4.7%] were Asian, 27 [14.1%] were Hispanic, 83 [43.2%] were non-Hispanic Black, and 68 [35.4%] were non-Hispanic White. Obstetric hemorrhage was the leading primary cause of SMM (83 [43.2%]), followed by COVID-19 infection (57 [29.7%]) and hypertensive disorders of pregnancy (17 [8.9%]). The SMM rate was highest among Hispanic patients (154.9 per 10 000 deliveries), primarily driven by COVID-19 infection. The rate of SMM among non-Hispanic Black patients was nearly 50% higher than for non-Hispanic White patients (119.9 vs 65.7 per 10 000 deliveries). The SMM outcome assessed could have been prevented in 61 events (31.8%). Clinician-level factors and interventions in the antepartum period were most frequently cited as potentially altering the SMM outcome. Practices that were performed well most often pertained to hospitals' readiness and adequate response to managing pregnancy complications. Recommendations for care improvement focused mainly on timely recognition and rapid response to such.
The findings of this cross-sectional study, which used hospital-based SMM surveillance and review beyond the mere exploration of administrative data, offers opportunities for identifying valuable quality improvement strategies to reduce SMM. Immediate strategies to reduce SMM in Maryland should target its most common causes and address factors associated with preventability identified at individual hospitals.
在美国，每年有超过 50000 名女性经历严重的产妇发病率（SMM），在过去 25 年中，SMM 发病率增加了一倍多。为应对这一情况，专业组织呼吁分娩机构常规识别和审查 SMM 事件，并确定预防机会。
使用马里兰州的 SMM 监测和审查计划，检查 SMM 水平、主要原因和与 SMM 可预防相关的因素。
设计、地点和参与者：本横断面研究纳入了 2020 年 8 月 1 日至 2021 年 11 月 30 日期间在马里兰州 6 家分娩医院分娩后 42 天或更短时间内住院的孕妇和产后患者。通过详细审查病历进行基于医院的 SMM 监测。
妊娠期间或产后 42 天内住院。
主要结局是入住重症监护病房、至少输注 4 U 红细胞和/或因 COVID-19 感染需要住院治疗。
共确定并审查了 192 例 SMM 事件。SMM 患者的平均[SD]年龄为 31[6.49]岁；9 例（4.7%）为亚裔，27 例（14.1%）为西班牙裔，83 例（43.2%）为非西班牙裔黑人，68 例（35.4%）为非西班牙裔白人。产科出血是 SMM 的主要主要原因（83 [43.2%]），其次是 COVID-19 感染（57 [29.7%]）和妊娠高血压疾病（17 [8.9%]）。西班牙裔患者的 SMM 发生率最高（每 10000 例分娩 154.9 例），主要由 COVID-19 感染驱动。非西班牙裔黑人患者的 SMM 发生率比非西班牙裔白人患者高近 50%（每 10000 例分娩 119.9 例和 65.7 例）。评估的 SMM 结果可预防 61 例（31.8%）。围产期的临床医生水平因素和干预措施最常被认为可能改变 SMM 结果。医院对管理妊娠并发症的准备情况和充分反应通常与经常进行的良好实践有关。护理改进的建议主要集中在及时识别和快速应对这些问题上。
这项横断面研究使用基于医院的 SMM 监测和审查，而不仅仅是探索行政数据，为确定有价值的质量改进策略以减少 SMM 提供了机会。马里兰州应立即采取减少 SMM 的策略，重点关注最常见的原因，并解决在个别医院确定的与可预防相关的因素。
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