| Objective:Based on an analysis of the etiology,the diagnosis,and the treatment of maternal near miss,the research aims to find possible solutions for reducing poor maternal prognosis,in order to improve maternal and infant outcomes.Methods:The clinical data of 26719 pregnant women hospitalized in obstetrics and ICU in Subei People’s hospital from January 2013 to December 2020 were collected.According to the diagnostic criteria of WHO on maternal near miss,a total of 288 cases were selected for retrospective analysis.The cases are going to be divided into three groups based on: 1)whether the patients were transferred to ICU or not 2)whether the patients were transferred from outside hospitals or not 3)the timing of referrals.SPSS25.0 was used to analyze the collected clinical data on their etiological composition,clinical diagnosis and treatment,and clinical outcomes.Results:(1)From 2013 to 2020,26,719 cases of pregnant women were admitted to obstetrics,including 288 cases of maternal near miss that ratios for 10.52 ‰.There are 27,378 cases of live birth,and 2 cases of maternal death.In addition,the severe maternal outcome ratio is up to 10.59 %,including 0.46 % of pregnant women that have transferred to ICU.Among the 288 cases of maternal near miss,107 cases needed to be transferred to the ICU due to their condition,and 181 cases were not transferred to the ICU.The ICU transfer rate of maternal near miss was 37.15%.109 cases were transferred from outside hospitals,and 179 cases were not transferred from outside hospitals.Among the referral cases,63 cases were prenatal referrals and 46 cases were postpartum referrals.(2)Among the main causes of 288 maternal near miss,227 cases(78.82%)were directly related to pregnancy,the main causes were postpartum hemorrhage and hypertensive disorders of pregnancy.There were 61 cases(21.18%)of pregnancy complicated with medical and surgical diseases,mainly central system diseases and blood system diseases.In maternal near miss cases,the most common causes of postpartum hemorrhage are placental factors(60.6%)and uterine weakness(37.4%).Severe preeclampsia(41.9%)and eclampsia(37.2%)are the most common components of hypertensive disorders of pregnancy in this study.(3)The comparison of age,height,admission weight,pregnancy times,parity,gestational week of delivery,total length of hospitalization,past delivery history,miscarriage history,household registration,method of conception,and perinatal survival rate between ICU and non-ICU groups,all P> 0.05,the differences were not statistically significant.The regular pregnancy check-ups rate 80.7% and the scarred uterus rate 39.8% of non-ICU group were significantly higher than those in the ICU group: 67.3% and 20.6% respectively(both P<0.05),the differences were statistically significant.The transfer rate of the ICU group was 52.3% and the rate of cesarean section 87.9%,were both higher than the rate of the non-ICU group,which is 29.8 % and 76.8 % respectively(both P<0.05),the differences were statistically significant.(4)Among the main causes of the ICU group,79 cases(73.8%)were directly related to pregnancy diseases,28 cases(26.2%)were complicated with medical and surgical diseases during pregnancy.The main causes were hypertensive disorder of pregnancy,postpartum hemorrhage,heart disease.Among the causes of cases that were not transferred to ICU,148 cases were pregnancy-related diseases(81.8%),33 cases were pregnancy complicated with medical and surgical diseases(18.2%).The main causes were postpartum hemorrhage,central nervous system disease,blood system diseases,and hypertensive disorder of pregnancy.The proportion of maternal near miss cases caused by postpartum hemorrhage in the non-ICU group was 70.7%,which was significantly higher than that in the ICU group 25.2%(P<0.05),and the proportion of maternal near miss cases caused by hypertensive disorder of pregnancy and heart disease in the ICU group was significantly higher than that in the non-ICU group(P<0.05),the differences are statistically significant.(5)In terms of treatment,the hysterectomy rate,reoperation rate,and continuous vasoactive drug application rate in the ICU group were significantly higher than those in the non-ICU group(all P<0.05),The differences were statistically significant.The blood transfusion rate,arterial embolization rate,application rate of tranexamic acid and Hemabate in the non-ICU group were significantly higher than those in the ICU group(all P<0.05),and the differences were statistically significant.There was no significant difference in ureteral stent implantation rate and uterine knapsack suture rate between the two groups(both P>0.05).(6)The 288 maternal near miss cases were divided into groups according to whether they were referred or not.Postpartum hemorrhage was the primary cause of maternal near miss in both groups.The proportion of maternal near miss caused by hypertensive disorder of pregnancy in the referral group(26.6%)was significantly higher than that in the non-referral group(7.8%)(P<0.05).The proportion of maternal near miss cases caused by central nervous system diseases in the nonreferral group(10.6%)was significantly higher than that in the non-referral group(1.8%)(P<0.05).The difference was statistically significant.The hysterectomy rate 18.3% and preterm birth rate 67% of referral group were significantly higher than those in the non-referral group: 7.3 % and 52 % respectively(both P<0.05),the differences were statistically significant.The comparison of blood transfusion rate,perinatal mortality,and abortion rate between the two groups were all P>0.05,and the differences were not statistically significant.(7)The 109 maternal near miss cases referred from outside hospitals were divided into prenatal referral group(63 cases)and postpartum referral group(46 cases).The etiological order of prenatal referral group was hypertensive disorder of pregnancy,postpartum hemorrhage,hematological disease and heart disease.The rate of cesarean section in prenatal referral group was significantly higher than that in postpartum referral group(P< 0.05),the difference was statistically significant.The main causes of the postpartum referral group were postpartum hemorrhage,hypertensive disorder of pregnancy,and amniotic fluid embolism,the gestational week,intrapartum hemorrhage,and blood product input.The blood transfusion rate and hysterectomy rate in postpartum referral group were significantly higher than those of the prenatal referral group(all P<0.05),and the differences were statistically significant.The proportion of maternal near miss cases caused by hypertensive disorder of pregnancy in prenatal referral group was significantly higher than that in postpartum referral group(P<0.05),and the proportion of maternal near miss cases caused by postpartum hemorrhage in postpartum referral group was significantly higher than that in prenatal referral group(P<0.05),the differences were statistically significant.There was no significant difference in total length of hospitalization and ICU transfer rate between the two groups(both P>0.05).(8)In this study,a total of 30 maternal near miss cases underwent hysterectomy,of which 17 cases were transferred to ICU and 13 cases were not transferred to ICU.The main cause of hysterectomy was complete placenta previa/placenta accreta(63.3%),uterine asthenia(20%),and Amniotic fluid embolism(10%).Conclusion:1.Postpartum hemorrhage and hypertensive disorder of pregnancy are the main causes of maternal near miss.Hypertensive disorder of pregnancy is the leading cause of maternal near miss transferred to ICU.2.Three preparations are helpful for lowering the occurrence of adverse maternal outcomes: to Strengthen maternal health care during pregnancy,to better evaluate pregnancy risk,and to guide pregnant women for regular obstetrics.3.Combining obstetrics with diverse medical multidiscipline is a major measure for the modern treatment of maternal near miss cases,especially with the combination of ICU.For pregnant women with severe complications during pregnancy or combined medical and surgical diseases,multidisciplinary diagnosis can ensure the safety of mother and child to the greatest extent,and lower the rate of the maternal mortality.4.It is extremely important to strictly follow rescue procedure and referral system.The first visit hospital should deal with the patient’s condition actively,give full play to the treatment level of each medical institution.Improving the ability to treat postpartum hemorrhage and hypertensive disorder of pregnancy is helpful to lower the rate of hysterectomy and maternal mortality. |
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