Huss M, Bongain A, Bertrandy M, Hofman P, Grimaud D, Gillet J Y
Service de Gynécologie-Obstétrique, Médecine de la Reproduction, Hôpital Boucicaut, Paris.
J Gynecol Obstet Biol Reprod (Paris). 1996;25(6):636-44.
To define the rate of maternal death on the basis of maternal deaths recorded from January 1986 to May 1993. To determine whether the patients had received "standard" quality health care.
A Reproductive Age Mortality Survey was performed retrospectively on causes of death in women from 14 to 45 years of age; death registries and clinical records at the Nice University Hospital were used.
There were 23 cases of pregnancy-associated death. Maternal mortality was 32.9 per 100000 live births. According to the INSERM survey, the "real" national rate would be 18.3 per 100000. This is a classical underestimation. The overmortality in Nice is partially explained by the AIDS epidemic which was the major cause of female deaths between 14 and 45 years (96/322). Nevertheless, there was an unsatisfactorily large number of cases in which standard obstetrical practises were not applied. This was often due to a combination of factors including poor obstetrical surveillance, insufficient attention by physicians, poor organisation of obstetrical care in the emergency room and referrals. Cesarean section was implicated in 7 out of 12 maternal deaths during the third trimester of pregnancy (58%). The cause of certain maternal deaths remained unexplained; amniotic embolus was always suggested. Unfortunately, an autopsy was performed in only 36% of the cases and its quality was insufficient to determine certain diagnosis.
根据1986年1月至1993年5月记录的孕产妇死亡情况确定孕产妇死亡率。确定患者是否接受了“标准”质量的医疗保健。
对14至45岁女性的死亡原因进行回顾性生殖年龄死亡率调查；使用了尼斯大学医院的死亡登记和临床记录。
有23例与妊娠相关的死亡。孕产妇死亡率为每10万活产32.9例。根据法国国家健康与医学研究院的调查，“实际”全国比率为每10万18.3例。这是典型的低估情况。尼斯的过高死亡率部分归因于艾滋病流行，艾滋病是14至45岁女性死亡的主要原因（96/322）。然而，仍有大量未应用标准产科操作的情况，令人不满意。这通常是多种因素共同作用的结果，包括产科监测不力、医生关注不足、急诊室产科护理组织不善以及转诊问题。剖宫产与妊娠晚期12例孕产妇死亡中的7例有关（58%）。某些孕产妇死亡原因不明；总是怀疑有羊水栓塞。不幸的是，仅36%的病例进行了尸检，且尸检质量不足以确定某些诊断。
