Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
Taiwan J Obstet Gynecol. 2024 Nov;63(6):867-873. doi: 10.1016/j.tjog.2024.03.024.
To investigate the prevalence and longitudinal trend of severe maternal morbidity (SMM) at nationwide level in Taiwan. The associated maternal factors contributing to SMM were also analyzed.
A population-based secondary analysis using administrative datasets released by Ministry of Health and Welfare of Taiwan from 2011 to 2021 was carried out. SMM was defined from ICD-9 or10-CM diagnosis and procedure codes previously released by CDC. The existence of any SMM indicators identified by delivery and postpartum hospitalizations between≧20 weeks of gestational age and within 42 days after childbirth was retrieved for analysis. Kendall Tau-b correlation was applied for trend test. Logistic regression was used to investigate the associated maternal factors for SMM. All the data were analyzed using SAS statistical software version 9.4. Statistical significance was defined as P value < 0.05.
A total of 2,054,010 delivery hospitalization records were identified during the study period. 6961 subjects met the SMM indicators, yielding an average SMM rate of 3.4 per 1000 deliveries. The pure transfusion rate was 2.33%. The overall SMM rate including transfusion reached 26.7 per thousand deliveries. The trend of SMM including and excluding transfusion demonstrated significantly increasing. Extreme maternal age and cesarean delivery were two main maternal associated factors for SMM.
Our findings demonstrated the steadily increasing trend of SMM in the past decade from nationwide study in Taiwan. The sharply growing rates of blood transfusion made the prevention of obstetric hemorrhage imperative. Health policies should be focused on the encourage of early childbearing and avoidance of unnecessary cesarean delivery to reduce the maternal risks associated with SMM. Continuous surveillance of SMM is required to improve obstetric care and reduce severe maternal complications.
在台湾全省范围内，调查严重产妇发病率（SMM）的流行情况和纵向趋势。分析导致 SMM 的相关产妇因素。
使用台湾卫生福利部发布的行政数据集，对 2011 年至 2021 年进行了一项基于人群的二次分析。SMM 是根据疾病控制和预防中心先前发布的 ICD-9 或 10-CM 诊断和程序代码定义的。检索了从妊娠 20 周以上到分娩后 42 天内分娩和产后住院期间任何 SMM 指标的存在情况进行分析。采用 Kendall Tau-b 相关系数进行趋势检验。Logistic 回归用于调查 SMM 的相关产妇因素。所有数据均使用 SAS 统计软件版本 9.4 进行分析。定义 P 值<0.05 为统计学显著。
研究期间共确定了 2054010 例分娩住院记录。6961 例符合 SMM 指标，发生率为每 1000 例分娩 3.4 例。纯输血率为 2.33%。包括输血在内的总体 SMM 率达到每千例分娩 26.7 例。包括和不包括输血的 SMM 趋势均呈显著增加。极端产妇年龄和剖宫产是 SMM 的两个主要产妇相关因素。
我们的研究结果表明，过去十年台湾全省 SMM 呈稳步上升趋势。输血率的急剧增长使得预防产科出血迫在眉睫。卫生政策应侧重于鼓励早生育和避免不必要的剖宫产，以降低与 SMM 相关的产妇风险。需要对 SMM 进行持续监测，以改善产科护理并减少严重产妇并发症。
