2014 年 1 月至 2019 年 6 月期间南非约翰内斯堡克里斯·哈尼·巴哈纳特大医院产妇死亡的围产期结局。

Perinatal outcome of maternal deaths at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, January 2014 - June 2019.

机构信息

Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

S Afr Med J. 2023 Sep 4;113(9):42-47. doi: 10.7196/SAMJ.2023.v113i9.724.

DOI:10.7196/SAMJ.2023.v113i9.724

PMID:37882129

Abstract

BACKGROUND

Maternal death is a tragic event. Of maternal deaths worldwide, 99% occur in low- and middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on fetal and neonatal outcome in the short and long term.

OBJECTIVES

To determine the perinatal outcomes of pregnancies that ended in a maternal death at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 5-year period, to describe the causes of maternal death, and to determine the stillbirth rate (SBR) and early neonatal death (ENND) rate in this population.

METHODS

This was a retrospective cross-sectional study of maternal deaths in women with a viable pregnancy from January 2014 to June 2019 at CHBAH. All maternal deaths with gestation >26 weeks or fetal weight >500 g were included in the study. Information on demographics, booking status, antenatal care, pregnancy outcome, and fetal and neonatal outcome was extracted from maternal and neonatal files.

RESULTS

Of a total of 183 maternal deaths during the study period, 147 were included in the study. The institutional maternal mortality ratio was 135 deaths per 100 000 live births. Hypertension was the main direct cause of death (36.5%; n=27/74), followed by pregnancy related sepsis (27.4%; n=21/74) and obstetric haemorrhage (20.6%; n=15/74). Non-pregnancy-related infections, of which 91.4% were HIV and HIV-related complications, comprised 47.9% (n=35/73) of indirect causes of death, followed by medical and surgical disorders. Of a total of 151 babies, including two sets of twins and one set of triplets, 137 were delivered and 14 were undelivered at the time of maternal death. Ninety-one babies (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 liveborn infants, 6 (6.5%) had an ENND. Of the 51 stillbirths, 14 (27.5%) were undelivered and 11 (21.6%) were delivered by perimortem caesarean section. The SBR was 347 per 1 000 maternal deaths and the ENND rate 66 per 1 000 live births. The perinatal mortality rate (PMR) was 388 per 1 000 maternal deaths, which is 12 times higher than the PMR per 1 000 live births for the general population.

CONCLUSION

Women who experience maternal death have babies with very poor perinatal outcomes, with a very high SBR, ENND rate and PMR. The health of the mother has a direct and significant effect on fetal and neonatal outcomes.

摘要

背景

产妇死亡是一件悲惨的事件。在全球产妇死亡中，99%发生在中低收入国家。围产期结局与产妇健康状况有关。产妇死亡对胎儿和新生儿的短期和长期结局有负面影响。

目的

在南非约翰内斯堡克里斯·哈尼·巴哈格瓦纳斯塔德学术医院（CHBAH），确定过去 5 年期间因产妇死亡而结束的妊娠的围产期结局，描述产妇死亡的原因，并确定该人群的死胎率（SBR）和早期新生儿死亡（ENND）率。

方法

这是一项回顾性的横断面研究，纳入了 2014 年 1 月至 2019 年 6 月期间在 CHBAH 因活产妊娠而死亡的产妇。所有妊娠 26 周以上或胎儿体重 500g 以上的产妇死亡均纳入研究。从产妇和新生儿档案中提取人口统计学、预约状态、产前护理、妊娠结局以及胎儿和新生儿结局的信息。

结果

在研究期间，共有 183 例产妇死亡，其中 147 例纳入研究。机构产妇死亡率为每 100 000 例活产 135 例死亡。高血压是主要的直接死亡原因（36.5%；n=27/74），其次是妊娠相关败血症（27.4%；n=21/74）和产科出血（20.6%；n=15/74）。非妊娠相关感染占 47.9%（n=35/73），其中 91.4%为 HIV 和与 HIV 相关的并发症，构成间接死亡原因的第二位，其次是医疗和外科疾病。在总共 151 名婴儿中，包括两对双胞胎和一组三胞胎，137 名婴儿分娩，14 名婴儿在产妇死亡时未分娩。91 名婴儿（61.9%）为活产，51 名（34.6%）为死胎。在 91 名活产婴儿中，有 6 名（6.5%）发生了早期新生儿死亡。在 51 例死胎中，14 例（27.5%）未分娩，11 例（21.6%）通过围产死亡剖宫产分娩。死胎率为每 1000 例产妇死亡 347 例，早期新生儿死亡（ENND）率为每 1000 例活产 66 例。围产期死亡率（PMR）为每 1000 例产妇死亡 388 例，是一般人群每 1000 例活产 PMR 的 12 倍。