Podder Debayan, Paul Bobby, Biswas Subhas C, Dasgupta Aparajita, Roy Soumit, Pal Arkaprovo
Department of Community Medicine, Raiganj Government Medical College Hospital, Raiganj, West Bengal, India.
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India.
Indian J Community Med. 2022 Oct-Dec;47(4):555-561. doi: 10.4103/ijcm.ijcm_183_22. Epub 2022 Dec 14.
Use of maternal near-miss (MNM) cases as an adjunct has been advocated to understand the processes of obstetric care because they share similar pathways as maternal deaths. Identifying the predictors and care pathway is crucial to improve the quality of care and end preventable maternal deaths.
This case-control study was conducted at a tertiary care facility in Kolkata from May 2019 to March 2020. Women admitted with complications during pregnancy, childbirth, or within 42 days of postpartum, who met the World Health Organization (WHO) near-miss criteria, were identified as cases, and equivalent age-group matched controls were recruited. Sample size of 60 cases and 60 controls was estimated, assuming a power of 80%, level of significance 0.05, and case-control ratio of 1. After obtaining approval from the institutional ethics committee and informed written consent from the participants, data was collected through face-to-face interview and review of records. Statistical analysis including care pathway analysis (using model) was performed using Statistical Package for Social Sciences version 16.
Joint family type (adjusted odds ratio [AOR] [CI] = 5.06 [1.48, 7.28]), lack of antenatal checkups (AOR [CI] = 7.85 [1.47, 12.09]), previous history of cesarean section (AOR [CI] = 3.94 [1.09, 14.33]), first delay in seeking care (AOR [CI] = 13.84 [3.62, 32.83]), and preexisting medical disorders (AOR [CI] = 11.03 [4.62, 22.80]) were identified as significant predictors of MNM in the adjusted model. Significant difference in the proportion of first and second delays in the care pathway was observed between cases and controls.
Identification of risk factors of MNM and pattern of delays in the care pathway will help improving quality of obstetric care.
由于孕产妇险些死亡（MNM）病例与孕产妇死亡有着相似的路径，因此提倡将其作为一种辅助手段来了解产科护理过程。识别预测因素和护理路径对于提高护理质量和终结可预防的孕产妇死亡至关重要。
本病例对照研究于2019年5月至2020年3月在加尔各答的一家三级护理机构进行。孕期、分娩期或产后42天内出现并发症且符合世界卫生组织（WHO）险些死亡标准的女性被确定为病例组，并招募年龄匹配的对照组。假设检验效能为80%、显著性水平为0.05且病例对照比为1，估计样本量为60例病例和60例对照。在获得机构伦理委员会批准并得到参与者的书面知情同意后，通过面对面访谈和记录审查收集数据。使用社会科学统计软件包第16版进行包括护理路径分析（使用模型）在内的统计分析。
在调整后的模型中，联合家庭类型（调整优势比[AOR][可信区间]=5.06[1.48,7.28]）、缺乏产前检查（AOR[可信区间]=7.85[1.47,12.09]）、既往剖宫产史（AOR[可信区间]=3.94[1.09,14.33]）、首次就诊延迟（AOR[可信区间]=13.84[3.62,32.83]）以及既往疾病（AOR[可信区间]=11.03[4.62,22.80]）被确定为MNM的显著预测因素。病例组和对照组在护理路径中首次和第二次延迟的比例存在显著差异。
识别MNM的危险因素和护理路径中的延迟模式将有助于提高产科护理质量。
