بررسی شیوع و عوامل مرتبط با عوارض شدید مادری (مادران نزدیک به مرگ) در اهواز، سال 1395

نوع مقاله : اصیل پژوهشی

نویسندگان

1 کارشناس ارشد مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

2 استادیار گروه مامایی، مرکز تحقیقات ارتقای سلامت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

3 دانشیار گروه مامایی، مرکز تحقیقات ارتقای سلامت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

4 استادیار گروه آمار حیاتی، دانشکده بهداشت، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

چکیده

مقدمه: امروزه برای ارزیابی بهتر کیفیت مراقبت‌های مامایی علاوه بر مرگ مادر، از یک شاخص مکمل مفید به نام مادران "نزدیک به مرگ" استفاده می‌شود؛ مادرانی که به‌خاطر عوارض بارداری یا زایمان تا پای مرگ رفته، اما نجات پیدا کرده‌اند. مطالعات بسیار اندکی در این خصوص در ایران انجام شده است، و در خوزستان تاکنون مطالعه‌ای برای بررسی این شاخص انجام نشده است. لذا مطالعه حاضر با هدف تعیین شیوع و عوامل مرتبط با موارد مادران "نزدیک به مرگ" در بیمارستان‌های اهواز در سال 1395 انجام شد.
روش‌کار: این مطالعه مقطعی بر روی 3002 زایمان در 5 بیمارستان دولتی اهواز از اول خرداد تا سوم مرداد سال 1395 انجام شد. معیارهای سازمان جهانی بهداشت برای مادران "نزدیک به مرگ" استفاده شد که شامل شرایط بالقوه تهدید‌کننده زندگی (اختلالات قلبی- عروقی، تنفسی، کلیوی، خونی و انعقادی، کبدی، نورولوژی) و معیارهای عوارض شدید مادری (خونریزی شدید پس از زایمان، پره‌اکلامپسی شدید، اکلامپسی، سپسیس یا عفونت شدید سیستمیک و پارگی رحم) بود. میزان شیوع موارد نزدیک به مرگ مادر و نیز عوامل مرتبط با آن بررسی شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های کای دو، تی تست، من ویتنی و رگرسیون لوجستیک انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: شیوع موارد "نزدیک به مرگ" مادر 6/29 مورد در 1000 تولد زنده بود. شایع‌ترین علت مستقیم آن پره‌اکلامپسی  (5/49%) و خونریزی شدید پس از زایمان (2/38%) بود. 26 نفر (2/29%) از مادران نزدیک به مرگ در بخش مراقبت ویژه بستری شدند. سن حاملگی پایین‌تر (001/0p<)، تحصیلات کمتر (008/0p<) و زایمان به روش سزارین (001/0p<) با احتمال بیشتری برای وقوع موارد "نزدیک به مرگ" مادر همراه بودند.
نتیجه‌گیری: همانند دلایل مرگ مادری، پره‌اکلامپسی و خون‌ریزی‌های زایمانی، دلایل اصلی موارد "نزدیک به مرگ" مادر بود. سزارین و سن پایین‌تر بارداری، احتمال وقوع موارد نزدیک به مرگ را افزایش می‌دهد.

کلیدواژه‌ها

عنوان مقاله [English]

Prevalence and related factors of maternal severe complications “Maternal Near Miss” in Ahvaz, 2016

نویسندگان [English]

  • Seyedeh Narges Hashemi 1
  • Poorandokht Afshari 2
  • Mojgan Javadnoori 3
  • Amal Saki Malehi 4
1 M.Sc. in Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2 Assistant professor, Department of Midwifery, Reproductive Health Promotion Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
3 Associate professor, Department of Midwifery, Reproductive Health Promotion Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
4 Assistant professor, Department of Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
چکیده [English]

Introduction: Today, for better assessment of midwifery care quality, in addition to maternal death, a useful supplementary indicator, called "maternal near miss" (MNM) is used. It means that mothers who have survived due to complications of pregnancy or childbirth. Limited studies have been conducted in this regard in Iran and no study has been performed in Khuzestan to evaluate this index. This study was performed with aim to determine the prevalence and factors related to MNM in Ahwaz hospitals in 2016.
Methods: This cross-sectional study was performed on 3002 delivery in 5 state hospitals in Ahwaz, from 22 May until 25 July 2016. WHO criteria was used for MNM including potential life-threatening conditions (cardiovascular, respiratory, renal, blood, coagulation, hepatic, and neurological disorders) and criteria for severe maternal complications (severe postpartum haemorrhage, severe pre-eclampsia, eclampsia, sepsis/severe systemic infection, and uterus rupture). The prevalence of MNM and related factors were investigated. Data were analyzed by SPSS software (version 22) and Chi-square, Mann-Whitney test, t-test and logistic regression. P<0.05 was considered statistically significant.
Results: The prevalence of MNM was 29.6 per 1,000 live births. The most common direct causes of MNM cases were preeclampsia (49.5%) and severe postpartum hemorrhage (38.2%). 26 of MNM (29.2%) were admitted in intensive care units. The lower gestational age (p <0.001), lower education level (p <0.008), and cesarean delivery (p <0.001) were more likely to resulted in cases of MNM.
Conclusion: As for the reasons of maternal death, preeclampsia and obstetrical hemorrhage were the main reasons for MNM. Cesarean and lower gestational age increase the likelihood of MNM.

کلیدواژه‌ها [English]

  • Life-threatening events
  • Maternal mortality
  • Pregnancy complications

مراجع

  1. Oladapo OT, Adetoro OO, Fakeye O, Ekele BA, Fawole AO, Abasiattai A, et al. National data system on near miss and Maternal death: shifting from maternal risk to public health impact in Nigeria. Reprod Health 2009; 6:8.
  2. UNFPA (United Nations Population Fund). 2018. Available at: https://www.unfpa.org/maternal-health.
  3. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2016; 387(10017):462-74.
  4. Iran’s ministry of health, maternal health department. Report on performance and achievements of national maternal mortality surveillance; 2018.
  5. Health Bureau of Population, Family and School Health Ministry. Sixth Development Plan to reduce maternal mortality; 2015.
  6. Say L, Souza JP, Pattinson RC, WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss--towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009; 23(3):287-96.
  7. World Health Organization‎. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. World Health Organization 2011. https://apps.who.int/iris/handle/10665/44692.
  8. Souza JP, Cecatti JG, Parpinelli MA, Krupa F, Osis MJ. An emerging "maternal near-miss syndrome": narratives of women who almost died during pregnancy and childbirth. Birth 2009; 36(2):149-58.
  9. Tunçalp Ö, Hindin MJ, Adu-Bonsaffoh K, Adanu RM. Assessment of Maternal near-miss and quality of care in a hospital-based study in Accra, Ghana. Int J Gynaecol Obstet 2013; 123(1):58-63.
  10. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams obstetrics. 24nd ed. New York: McGraw-Hill; 2014.
  11. Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG 2012; 119(6):653-61.
  12. Jayaratnam S, Kua S, deCosta C, Franklin R. Maternal ‘near miss’ collection at an Australian tertiary maternity hospital. BMC Pregnancy Childbirth 2018; 18(1):221.
  13. Naderi T, Foroodnia Sh, Omidi S, Samadani F, Nakhaee N. Incidence and Correlates of Maternal Near Miss in Southeast Iran. International Journal of Reproductive Medicine 2015; 1-5.
  14. Ghazivakili Z, Lotfi R, Kabir K, Norouzi Nia R, Rajabi Naeeni M. Maternal near miss approach to evaluate quality of care in Alborz province, Iran. Midwifery 2016; 41:118-124.
  15. Mohammadi S. Beyond ‘Cesarean Overuse’ : Hospital-Based Audits of Obstetric Care and Maternal Near Miss in Tehran, Iran [Internet] [PhD dissertation]. [Uppsala]; 2016. (Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine). Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-308081
  16. Souza JP, Cecatti JG, Faundes A, Morais SS, Villar J, Carroli G, et al. Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal health. Bull World Health Organ 2010; 88(2):113-119.
  17. Health Center of Khuzestan (Ahwaz). Maternity ward; 2015-2016.
  18. Ali AA, Khojali A, Okud A, Adam GK, Adam I. Maternal near-miss in a rural hospital in Sudan. BMC Pregnancy Childbirth 2011; 11:48.
  19. Mohammadinia N, Samieezadeh Toosi T, Rezaei MA, Rostaei F. Investigating the Frequency and Effective Factors on Maternal Mortality in Sistan and Baluchistan Province, Iran, 2002-2009. Iran J Obstet Gynecol Infertil 2013; 16(44):28-34.
  20. Ashouri N, Kordi M, Shakeri MT, Tara F. Vaginal delivery Postpartum Hemorrhage: Incidence, Risk Factors, and Causes. Iran J Obstet Gynecol Infertil 2019; 21(12):65-76.
  21. Shrestha NS, Saha R, Karki C. Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J 2010; 8(30):222-6.
  22. Nelissen EJ, Mduma E, Ersdul HL, Evjen-olsen B, Roosmaken J, Stekelenburg J. Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study. BMC Pregnancy and Childbirth 2013; 13:141.
  23. Galvão LP, Alvim-Pereira F, de Mendonça CM, Menezes FE, Góis KA, Ribeiro RF Jr, et al. The prevalence of severe maternal morbidity and near miss and associated factors in sergipe, Northeast Brazil. BMC pregnancy childbirth 2014; 14:25.
  24. Saleh Gargari S, Essén B, Fallahian M, Mulic-Lutvica A, Mohammadi S. Auditing the appropriateness of cesarean delivery using the Robson classification among women experiencing a maternal near miss. Int J Gynaecol Obstet 2019; 144(1):49-55.
  25. Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M, Asl Amin Abad R. Prevalence and Causes of Cesarean Section in Iran: Systematic Review and Meta-Analysis. Iran J Public Health 2014; 43(5):545-555.
  26. Moudi Z, Arabnezhad L, Tabatabaei SM. Severe Maternal Outcomes in a Tertiary Referral Teaching Hospital in Sistan and Baluchistan Province, Iran: A Cross Sectional Study. Med Surg Nurs J 2018; 7(3):e86309.
  27. Pacheco AJ, Katz L, Souza AS, de Amorim MM. Factors associated with severe maternal morbidity and near miss in the São Francisco Valley, Brazil: a retrospective, cohort study. BMC Pregnancy Childbirth 2014; 14:91.
  28. Mawarti Y, Utarini A, Hakimi M. Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:149.
  29. Tunçalp Ö, Hindin MJ, Adu-Bonsaffoh K, Adanu R. Listening to women’s voices: the quality of care of women experiencing severe maternal morbidity, in Accra, Ghana. PloS one 2012; 7(8):e44536.
  30. Storeng KT, Drabo S, Ganaba R, Sundby J, Calvert C, Filippi V. Mortality after near-miss obstetric complications in Burkina Faso: medical, social and health-care factors. Bull World Health Organ 2012; 90(6):418-425B.
  31. Cecatti JG, Souza JP, Oliveira Neto AF, Parpinelli MA, Sousa MH, Say L, et al. Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss. Reprod Health 2011; 8:22.

مجله زنان، مامایی و نازایی ایران
دوره 23، شماره 2
اردیبهشت 1399
صفحه 78-87

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