Sprague Ann E, Roberts Nicole F, Lavin Venegas Carolina, Nath Tatung, Shah Prakesh S, Barrett Jon, Cook Jocelynn, Darling Elizabeth K, D'Souza Rohan, Dore Sharon, Edwards Wesley, Kasman Naomi, Dzakpasu Susie, Ray Joel, Walker Mark
Better Outcomes Registry and Network (BORN), Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
Better Outcomes Registry and Network (BORN), Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
J Obstet Gynaecol Can. 2024 Dec;46(12):102689. doi: 10.1016/j.jogc.2024.102689. Epub 2024 Oct 12.
Maternal death during or after pregnancy is often preventable and accurate surveillance is key to prevention. We examined the number and causes of maternal death in Ontario over 20 years.
Retrospective cohort study including all hospital livebirths and stillbirths from 2002-2022 in the Canadian Institute for Health Information Discharge Abstracts (for hospitalizations) and National Ambulatory Care System (for emergency department encounters) linked to the Better Outcomes and Registry and Network births. Death was ascertained from childbirth to 365 days thereafter; all deaths were reviewed by at least 3 clinicians.
There were 485 deaths among 2 764 214 live and stillbirths over 20 years-a maternal mortality ratio (MMR) of 17.5 per 100 000 (95% CI 16.0-19.2). There were 222 (45.8%) early deaths within 42 days of birth (MMR of 8.0 per 100 000; 95% CI 7.0-9.2), and 263 (54.2%) late deaths from 43 to 365 days after birth (MMR 9.5 per 100 000; 95% CI 8.4-10.7). Death was pregnancy-related in 169/485 cases (34.8%). Early death causes were predominantly hemorrhage, infection, preeclampsia, and pulmonary embolism. The top causes of 263 late deaths were cancer, injury, and cardiac arrest, or unknown.
Most deaths within 1 year of childbirth are not related to obstetrical factors; however, pregnancy complications factor in early deaths. Causes of early and late deaths differ, but examining late deaths is equally important to identify factors not regularly examined in maternal mortality. As death in early pregnancy or outside hospitals is not reported, mortality is likely higher.
孕期或产后的孕产妇死亡通常是可预防的，准确监测是预防的关键。我们研究了安大略省20年间孕产妇死亡的数量和原因。
回顾性队列研究，纳入2002年至2022年加拿大卫生信息研究所出院摘要（用于住院治疗）和国家门诊护理系统（用于急诊科就诊）中所有与“更好结局与登记及网络分娩”相关的医院活产和死产病例。从分娩至其后365天确定死亡情况；所有死亡病例均由至少3名临床医生进行审查。
20年间，2764214例活产和死产中有485例死亡——孕产妇死亡率（MMR）为每10万例17.5例（95%置信区间16.0 - 19.2）。出生后42天内有222例（45.8%）早期死亡（MMR为每10万例8.0例；95%置信区间7.0 - 9.2），出生后43天至365天有263例（54.2%）晚期死亡（MMR为每10万例9.5例；95%置信区间8.4 - 10.7）。485例病例中有169例（34.8%）死亡与妊娠相关。早期死亡原因主要是出血、感染、先兆子痫和肺栓塞。263例晚期死亡的主要原因是癌症、损伤和心脏骤停，或原因不明。
分娩后1年内的大多数死亡与产科因素无关；然而，妊娠并发症是早期死亡的因素之一。早期和晚期死亡原因不同，但检查晚期死亡对于识别孕产妇死亡率中未经常检查的因素同样重要。由于妊娠早期或院外死亡未被报告，实际死亡率可能更高。
