Aflaki Kayvan, Vigod Simone N, Sprague Ann E, Cook Jocelynn, Berger Howard, Aoyama Kazuyoshi, Jhirad Reuven, Ray Joel G
Institute of Medical Science, University of Toronto, Toronto, Canada.
Department of Psychiatry, Women's College Hospital, Toronto, Canada.
J Obstet Gynaecol Can. 2024 Apr;46(4):102349. doi: 10.1016/j.jogc.2024.102349. Epub 2024 Jan 6.
Knowledge regarding the antecedent clinical and social factors associated with maternal death around the time of pregnancy is limited. This study identified distinct subgroups of maternal deaths using population-based coroner's data, and that may inform ongoing preventative initiatives.
A detailed review of coroner's death files was performed for all of Ontario, Canada, where there is a single reporting mechanism for maternal deaths. Deaths in pregnancy, or within 365 days thereafter, were identified within the Office of the Chief Coroner for Ontario database, 2004-2020. Variables related to the social and clinical circumstances surrounding the deaths were abstracted in a standardized manner from each death file, including demographics, forensic information, nature and cause of death, and antecedent health and health care factors. These variables were then entered into a latent class analysis (LCA) to identify distinct types of deaths.
Among 273 deaths identified in the study period, LCA optimally identified three distinct subgroups, namely, (1) in-hospital deaths arising during birth or soon thereafter (52.7% of the sample); (2) accidents and unforeseen obstetric complications also resulting in infant demise (26.3%); and (3) out-of-hospital suicides occurring postpartum (21.0%). Physical injury (22.0%) was the leading cause of death, followed by hemorrhage (16.8%) and overdose (13.3%).
Peri-pregnancy maternal deaths can be classified into three distinct sub-types, with somewhat differing causes. These findings may enhance clinical and policy development aimed at reducing pregnancy mortality.
关于妊娠前后与孕产妇死亡相关的先前临床和社会因素的知识有限。本研究利用基于人群的验尸官数据确定了孕产妇死亡的不同亚组，这可能为正在进行的预防措施提供信息。
对加拿大安大略省进行了详细的验尸官死亡档案审查，该省有单一的孕产妇死亡报告机制。在安大略省首席验尸官办公室2004 - 2020年数据库中确定了妊娠期间或之后365天内的死亡情况。与死亡周围社会和临床情况相关的变量以标准化方式从每个死亡档案中提取，包括人口统计学、法医信息、死亡性质和原因以及先前的健康和医疗因素。然后将这些变量纳入潜在类别分析（LCA）以确定不同类型的死亡。
在研究期间确定的273例死亡中，LCA最佳地确定了三个不同的亚组，即：（1）分娩期间或之后不久发生的院内死亡（占样本的52.7%）；（2）意外事故和不可预见的产科并发症也导致婴儿死亡（26.3%）；以及（3）产后院外自杀（21.0%）。身体损伤（22.0%）是主要死因，其次是出血（16.8%）和药物过量（13.3%）。
围孕期孕产妇死亡可分为三种不同亚型，原因略有不同。这些发现可能会加强旨在降低妊娠死亡率的临床和政策制定。
