安大略省分娩后的死亡率--二十年来的时间趋势和原因分析。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2024-10-12 DOI:10.1016/j.jogc.2024.102689

Ann E. Sprague RN, PhD , Nicole F. Roberts MSc , Carolina Lavin Venegas BScN, MSc , Tatung Nath MSc , Prakesh S. Shah MD, MSc , Jon Barrett MBBch, MD, MRCOG , Jocelynn Cook PhD, MBA , Elizabeth K. Darling RM, MSc, PhD , Rohan D’Souza MD, PhD , Sharon Dore RN, PhD , Wesley Edwards MBBS, MPH , Naomi Kasman MSc , Susie Dzakpasu PhD , Joel Ray MD , Mark Walker MD, MSc, MSHCM

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引用次数: 0

摘要

目的：孕产妇在怀孕期间或之后死亡通常是可以预防的，准确的监测是预防的关键。我们研究了安大略省 20 年来孕产妇死亡的数量和原因：回顾性队列研究包括加拿大健康信息研究所（CIHI）出院摘要（住院）和国家非住院护理系统（急诊科就诊）中 2002-2022 年所有住院活产和死产的情况，并与更好结果和登记（BORN）出生情况相联系。所有死亡病例均由至少 3 名临床医生审查：20 年间，2 764 214 例活产和死产中有 485 例死亡，孕产妇死亡率（MMR）为十万分之 17.5（95% CI 16.0-19.2）。有 222 例（45.8%）早期死亡发生在产后 42 天内（孕产妇死亡率为每 100 000 例中有 8.0 例；95% CI 为 7.0-9.2 例），263 例（54.2%）晚期死亡发生在产后 43 天至 365 天内（孕产妇死亡率为每 100 000 例中有 9.5 例；95% CI 为 8.4-10.7 例）。169/485例（34.8%）的死亡与妊娠有关。早期死亡原因主要是出血、感染、子痫前期和肺栓塞。263 例晚期死亡病例的主要死因是癌症、外伤、心脏骤停或原因不明：结论：大多数产后一年内的死亡与产科因素无关；然而，妊娠并发症是导致早期死亡的因素。早期死亡和晚期死亡的原因各不相同，但检查晚期死亡同样重要，因为这可以发现孕产妇死亡中未经常检查的因素。由于未报告孕早期死亡或医院外死亡，死亡率可能更高。

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Mortality Following Childbirth in Ontario: A 20-Year Analysis of Temporal Trends and Causes

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.