The Analysis Of Critically Ⅲ Obstetric Patients’Clinical Characteristic And Pregnancy Outcome

Objectives: To analyze the clinical characteristics and outcomes of criticalmaternal, in order to further improve the level of treatment of severe maternal,lower the critical maternal mortality and the perinatal mortality.Methods: Collected during August2006to August2013, the first affiliatedhospital of fujian medical university at the records of195cases of severe diseaseof obstetrics and gynecology clinical cases were analyzed retrospectively, toexplore critical of the leading causes of maternal。The meaning of maternal riskscore， acute physiology and chronic health evaluation system II (acutephysiology and chronic health valuation, APACHE Ⅱ), Sequential Organ Failurescore system (Sequential Organ Failure Assessment, SOFA) three scoring systemin assessing severe maternal condition and outcome of mother and fetus，and thereason and time of the termination of pregnancy, impact on maternal andoutcomes in acute. Using SPSS statistical processing17.0system, application ofnormality test, single factor analysis of variance, chi-square, Fisher’s exactprobability method and t test.Results:195cases of severe maternal,145cases of severe maternal stayed inIntensive care unit (ICU),50cases of not ICU admission.(1).195cases of severeclinical cases,11cases severe maternal death, pregnancy with multiple organfailure (MODS)31cases， transfered from other hospitals17cases, all are thePregnant women admitted to the ICU.(2). Gestational hypertension relateddiseases, obstetric hemorrhage is the most important two makes a criticalmaternal causes is also constitute the main cause of maternal and infant death.(3).Rural maternal mortality is significantly higher than the city, but the incidence ofmaternal deaths dropped year by year.(4). By using three kinds of gradingsystem to evaluate maternal illness and critical and outcomes, including maternalobstetric critical risk score is suitable for prenatal screening high-risk factors, but not to predict and outcomes; APACHEII scoring system for maternal andoutcomes have good predictive value; SOFA score is suitable for the severematernal condition assessment and maternal outcome prediction, but does notapply to the perinatal outcome assessment.(5). The pregnancy is terminatedbecause of fetal factors the perinatal death rate is high,34~36+6weeksgestation, maternal mortality and the perinatal mortality rates are low.Conclusion:(1)The antenatal examination should use the high risk of maternalgrading system when screening for obstetric critical risk factors, helps to controlobstetric critical illness development;(2)When the obstetric critical case occurs,use APACHEII scoring system to evaluate critically ill maternal illness, andWhen APACHEII score score higher than15points of maternal high positiverate of multiple organ failure and maternal and infant mortality, need as soon aspossible into the ICU care treatment actively, in order to as early as possiblethrough the crisis;(3)Combination of two or more organ function failure ofcritically high maternal mortality， SOFA D3-1≥0prompt critical maternalillness dangerous, even with deteriorating trend, should according to the differentorgans of causes in a timely manner appropriate protection and support treatment,prevent obstetric critical further development;(4) In the case of ensure life safetycritical maternal, should be extended more than34weeks’ gestation weeks to asmuch as possible, in order to improve the viability of the fetus.