Granja A C, Machungo F, Gomes A, Bergström S, Brabin B
Ministry of Health, Maputo, Mozambique.
Ann Trop Med Parasitol. 1998 Apr;92(3):257-63. doi: 10.1080/00034989859816.
All pregnancy-related maternal deaths that occurred at the central hospital of Maputo during the 5 years between 1989 and 1993 were reviewed. The 239 maternal deaths recorded represented a maternal mortality ratio of 320/100,000 live births. Overall, 15.5% of the deaths were directly attributable to malaria, and 19.7% of the women who died were found to be parasitaemic (with Plasmodium falciparum) prior to death. Autopsies on 161 of the women who died showed histological evidence of malarial infection in the spleens of 44 (27.3%). Many (37.8%) of the malaria-related deaths occurred in adolescent primigravidae, and most were associated with severe anaemia. Pregnancy outcome was generally poor. Unbooked deliveries, and poor antenatal care were identified as risk factors for maternal death from malaria. The current policy of prescribing antimalarials in pregnancy based on symptomatic malaria alone should be reviewed. Improved primary prevention is required in order to reduce the high risk of malaria-related mortality in all pregnant women in the urban study area, especially among adolescents.
对1989年至1993年这5年间在马普托中心医院发生的所有与妊娠相关的孕产妇死亡病例进行了回顾。记录的239例孕产妇死亡病例代表孕产妇死亡率为每10万活产320例。总体而言，15.5%的死亡直接归因于疟疾，19.7%的死亡妇女在死亡前被发现有疟原虫血症（恶性疟原虫）。对161例死亡妇女进行的尸检显示，44例（27.3%）的脾脏有疟疾感染的组织学证据。许多（37.8%）与疟疾相关的死亡发生在青春期初产妇中，且大多数与严重贫血有关。妊娠结局总体较差。未登记分娩和产前护理不佳被确定为孕产妇死于疟疾的危险因素。应重新审视目前仅根据症状性疟疾在孕期开抗疟药的政策。需要加强一级预防，以降低城市研究地区所有孕妇，尤其是青少年中与疟疾相关的高死亡率风险。
