2018 - 2022年南非一家三级医院中COVID-19大流行之前及期间的孕产妇死亡：原因及可避免因素
Maternal deaths before and during COVID-19 pandemic: Causes and avoidable factors in a tertiary hospital in South Africa, 2018‒2022.
作者信息
Lunda Ongombe, Chauke Lawrence, Daef Ghada, Olorunfemi Gbenga, Ngene Nnabuike Chibuoke
机构信息
Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Obstetrics and Gynaecology, Klerksdorp Hospital, Klerksdorp, North West, South Africa.
出版信息
PLoS One. 2025 Jun 24;20(6):e0326424. doi: 10.1371/journal.pone.0326424. eCollection 2025.
AIM
To determine the institutional maternal mortality ratio (iMMR) and avoidable factors (AVFs) before and during the COVID-19 pandemic in a tertiary hospital in South Africa.
METHODS
This was a retrospective cross-sectional study. We reviewed medical records to compare iMMR and associated AVFs two years before (March 2018 - February 2020) and two years during (March 2020 - February 2022) COVID-19 pandemic.
RESULTS
Fifty-eight maternal deaths were recorded but available data was 57 (35 before and 22 during COVID-19 pandemic). The highest iMMR per 100,000 live births over a 12-month period was 329.1 before and 201.8 during COVID-19 pandemic. The mean ages were 31.0 ± 6.9 and 31 ± 6.2 years, p = 0.822 before and during COVID-19 pandemic, respectively. During COVID-19 pandemic, 40.9% (9/22) were diagnosed with COVID-19. Before and during the pandemic, 71.4% (25/35) and 68.2% (15/22) p = 1.0 were admitted into an intensive care unit (ICU), respectively, with corresponding 74.3% (26/35) and 50% (11/22), p = 0.026 requiring mechanical ventilation. There was a significant difference in the primary causes of death (p = 0.009) for the two periods, with preeclampsia with severe features (22.9%, 8/35) being the leading cause before COVID-19 pandemic compared to COVID-19 (31.8%, 7/22) during the pandemic. AVFs related to healthcare professionals were the most common occurring in 22/35 and 12/22 of the deceased before and during COVID-19 pandemic, respectively. Before COVID-19 pandemic, the most frequent patient-, healthcare professional-, and administrative-related AVFs were failure to book for antenatal care, administration of wrong treatment, and lack of ICU/high care bed spaces, respectively. During COVID-19 pandemic, the most common patient-, healthcare professional- and administrative-related AVFs were delay in seeking medical treatment, lack of critical care skills, and unavailability of ICU/high-care bed spaces, respectively.
CONCLUSION
iMMR was lower during than before the COVID-19 pandemic. AVFs related to healthcare professionals were the most common.
目的
确定南非一家三级医院在新冠疫情之前及期间的机构孕产妇死亡率（iMMR）和可避免因素（AVF）。
方法
这是一项回顾性横断面研究。我们查阅病历以比较新冠疫情前两年（2018年3月 - 2020年2月）和疫情期间两年（2020年3月 - 2022年2月）的iMMR及相关AVF。
结果
记录了58例孕产妇死亡，但可用数据为57例（新冠疫情前35例，疫情期间22例）。在12个月期间，每10万例活产中最高的iMMR在新冠疫情前为329.1，疫情期间为201.8。平均年龄在新冠疫情前为31.0±6.9岁，疫情期间为31±6.2岁，p = 0.822。在新冠疫情期间，40.9%（9/22）被诊断出感染新冠。在疫情前和疫情期间，分别有71.4%（25/35）和68.2%（15/22），p = 1.0入住重症监护病房（ICU），相应地，需要机械通气的比例分别为74.3%（26/35）和50%（11/22），p = 0.026。两个时期的主要死亡原因存在显著差异（p = 0.009），在新冠疫情前，重度子痫前期（占22.9%，8/35）是主要死因，而在疫情期间，新冠感染（占31.8%，7/22）是主要死因。与医护人员相关的可避免因素最为常见，在新冠疫情前和期间分别占死亡病例的22/35和12/22。在新冠疫情前，最常见的与患者、医护人员和行政相关的可避免因素分别是未预约产前检查、错误治疗以及ICU/高级护理床位不足。在新冠疫情期间，最常见的与患者、医护人员和行政相关的可避免因素分别是就医延迟、缺乏重症护理技能以及ICU/高级护理床位不可用。
结论
新冠疫情期间的iMMR低于疫情前。与医护人员相关的可避免因素最为常见。
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