孕产妇危重事件发生率及防控策略研究进展

过去孕产妇死亡率是衡量一个国家或地区妇女健康状况和社会经济发展的重要指标之一。2019年美国疾病控制中心收集全国孕产妇死亡信息得出结论:如果采取行动,多达一半的孕产妇死亡是可预防的。随着2000年联合国“千年发展目标”的提出以及各国对孕产妇健康的重视,孕产妇死亡已经成为极低概率事件,而孕产妇危重事件发生率(severe maternal morbidity,SMM)已成为比孕产妇死亡率更常见和有用的产科护理指标。在美国,约50名经历SMM孕产妇中发生1例死亡。虽然孕产妇死亡率历来是孕产妇结局的关键指标,SMM的流行情况却可以为围生期健康提供更全面的信息,也是监测孕产妇结局的一种方法。同时,SMM通常是孕产妇死亡的先兆,作为导致孕产妇死亡的动态过程和前期指标,SMM对强化孕产妇管理、降低孕产妇死亡率有重要意义。许多国家开始将SMM作为评价产科质量的重要指标之一。防控SMM,除了常规策略外,避免医疗相关的延迟,使用孕产妇早期预警触发工具(MEWT)有重要临床价值。

Research Progress on Severe Maternal Morbidity and Prevention and Control Strategies

In the past,maternal mortality(MMR)was an important indicator of women′s health and socio-economic development in a country or region.In 2019,the U.S.Centers for Disease Control and Prevention collected information on maternal deaths across the country and concluded that up to half of all maternal deaths are preventable if action is taken.With the introduction of the millennium development goals(MDGS)in 2000 and countries′emphasis on maternal health,maternal death has become a very low probability event,while the incidence of severe maternal morbidity(SMM),that is,the incidence of critical maternal events,has become a more common and useful indicator of obstetric care than mortality.For every maternal death in the United States,about 50 women experience SMM.Although MMR has traditionally been a key indicator of maternal outcomes,the prevalence of SMM can provide more comprehensive information on perinatal health and is a way to monitor maternal outcomes.At the same time,SMM is usually a precursor of maternal death,and as a dynamic process leading to maternal death and a preliminary indicator,it has important clinical significance for strengthening maternal management and thus reducing MMR.Many countries have begun to take the incidence of SMM as one of the important indicators to evaluate the quality of obstetrics.Controlling the occurrence and development of severe maternal morbidity can reduce maternal mortality.Prevention and control of SMM,in addition to conventional strategies,to avoid medically related delays,the use of maternal early warning trigger tool(MEWT)has important clinical value.