risk factors for progression from severe maternal morbidity to death a national cohort study进展的风险因素从产妇发病率严重到死亡一个全国性的队列研究.pdfVIP

Risk Factors for Progression from Severe Maternal Morbidity to Death: A National Cohort Study 1 1,2 1,3,4 4 2 Gilles Kayem , Jennifer Kurinczuk , Gwyneth Lewis , Shona Golightly , Peter Brocklehurst , Marian Knight1,2* 1 National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom, 2 Policy Research Unit in Maternal Health and Care, University of Oxford, Oxford, United Kingdom, 3 Department of Health, London, United Kingdom, 4 Centre for Maternal and Child Enquiries, London, United Kingdom Abstract Background: Women continue to die unnecessarily during or after pregnancy in the developed world. The aim of this analysis was to compare women with severe maternal morbidities who survived with those who died, to quantify the risk associated with identified factors to inform policy and practice to improve survival. Methods and Findings: We conducted a national cohort analysis using data from two sources obtained between 2003 and 2009: the Centre for Maternal and Child Enquiries maternal deaths database and the United Kingdom Obstetric Surveillance System database. Included women had eclampsia, antenatal pulmonary embolism, amniotic fluid embolism, acute fatty liver of pregnancy or antenatal stroke. These conditions were chosen as major causes of maternal mortality and morbidity about which data were available through both sources, and include 42% of direct maternal deaths over the study period. Rates, risk ratios, crude and adjusted odd ratios were used to investigate risks factors for maternal death. Multiple imputation and sensitivity analysis were used to handle missing data. We identified 476 women who survived and 100 women who died. Maternal death was associated with older