علل مرگ‌های مادری در بیمارستان‌های آموزشی دانشگاه علوم پزشکی زاهدان با رویکرد ICD-MM در سال‌های 97-1390

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار، مرکز تحقیقات سلامت بارداری، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران. استادیار، گروه فناوری اطلاعات سلامت، دانشکده پیراپزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

2 کارشناس ارشد گروه فناوری اطلاعات سلامت، دانشکده پیراپزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

3 کارشناس مامایی، بیمارستان علی بن ابیطالب، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

4 استادیار، گروه فناوری اطلاعات سلامت، دانشکده پیراپزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران. استادیار، مرکز تحقیقات ارتقاء سلامت، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران.

چکیده

مقدمه: استفاده سازمان جهانی بهداشت از دهمین ویرایش کتاب طبقه‌بندی بین‌المللی بیماری‌ها برای مرگ‌های در طول بارداری، زایمان و دوران نفاسی (ICD-MM) منجر به درک صحیح‌تری از مرگ‌های مادری می‌شود. مطالعه حاضر با هدف تعیین علل مرگ مادران باردار در بیمارستان‌های آموزشی دانشگاه علوم پزشکی زاهدان با استفاده از ICD-MM انجام شد.
روش‌کار: در این مطالعه مقطعی که در سال 1398 انجام شد، 107 پرونده مربوط به مادران باردار متوفی در فاصله سال‌های 97-1390 در زاهدان مورد بررسی قرار گرفتند. کدگذاری علل مرگ با استفاده از کتاب‌های ICD-MM همراه با سه جلد از ویرایش دهم کتاب‌های‌ طبقه‌بندی بین‌المللی بیماری‌ها و مشکلات بهداشتی مرتبط (ICD-10) انجام شد. داده‌های مورد نظر در فرم گردآوری داده‌‌ها ثبت و با استفاده از نرم‌افزار آماری SPSS (نسخه 15) مورد تجزیه و تحلیل قرار گرفتند.
یافته‌ها: در طی 8 سال مورد مطالعه، 107 مورد مرگ‌ مادری رخ داد. نسبت مرگ مادری در جامعه پژوهش 254 در صد هزار تولد زنده و میانگین سنی زنان باردار فوت ‌شده 3/7±7/31 سال بود. علل مستقیم (8/73%)، علل غیرمستقیم (6/20%)، علل نامشخص (8/2%) و تصادفی (8/2%) از علل منجر به مرگ‌های مادری بودند. از 9 گروه ذکر شده در ICD-MM، گروه‌های سایر عوارض مامایی (4/22%)، خونریزی مامایی (6/20%) و عوارض غیرمامایی (6/20%)، بیشترین سهم را در مرگ‌های مادری داشتند.
نتیجه‌گیری: اختلالات انعقادی پس از زایمان، سپسیس و سایر بیماری‌های خونی و اندام‌های خون‌ساز و سایر اختلالات خاص دستگاه ایمنی به‌ترتیب سه علت اصلی منجر به مرگ‌های مادری در این مطالعه بودند. بنابراین، پیش‌بینی خونریزی و آمادگی برای مقابله با آن مانند دسترسی سریع به خون و فرآورده‌های آن، غربالگری مادران بارداری که دارای بیماری‌های خونی هستند و ارائه آموزش و مراقبت تخصصی به آنها و همچنین توجه بیشتر به مراقبت‌های پس از زایمان تا حداقل 42 روز پس از زایمان به‌خصوص در مواردی که دارای خونریزی و عفونت پس از زایمان هستند، می‌توانند در پیشگیری بیشتر مرگ‌های مادری مؤثر واقع شوند.

کلیدواژه‌ها


عنوان مقاله [English]

Causes of maternal mortalities in educational hospitals of Zahedan University of Medical Sciences with ICD-MM approach from 2011 to 2018

نویسندگان [English]

  • Afsaneh Karimi 1
  • Farzaneh Shahbakhsh 2
  • Sonia Nourouzi-Chegani 3
  • Jahanpour Alipour 4
1 Assistant Professor, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. Assistant Professor, Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences,
2 M.Sc. of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran.
3 B.Sc. in Midwifery, Ali-ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
4 Assistant Professor, Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran. Assistant Professor, Health Promotion Research Center, Zahedan University of Medical Sciences,
چکیده [English]

Introduction: The WHO application of ICD-10 to deaths during pregnancy, childbirth and the puerperium (ICD-MM) leads to a better understanding of maternal mortalities. This study was performed with aim to determine the causes of pregnant mothers' mortalities in the educational hospitals of Zahedan University of Medical Sciences using the ICD-MM.
Methods: In this cross-sectional study which was conducted in 2019, 107 records of pregnant mothers' mortalities occurred in Zahedan in 2011-2018 were studied. The causes of deaths were coded using ICD-MM with three volumes of ICD-10 (The 10th revision of the International Statistical Classification of Diseases and Related Health Problems). Data were recorded in the data collection form and were analysed by SPSS software (version 15).
Results: During 8-years of the study period, 107 cases of maternal mortality occurred. The maternal mortality ratio in the study population was 254 per 100,000 live births and the mean age of dead pregnant mothers was 31.7 ± 7.3 years. Direct causes with 73.8%, indirect causes with 20.6%, unspecified causes with 2.8% and coincidental causes with 2.8% were responsible for maternal mortalities. Other obstetric complications with 22.4%, obstetric hemorrhage and non-obstetric complications with 20.6% had the most values in maternal mortalities between nine groups listed in the ICD-MM.
Conclusion: Postpartum coagulation defects, puerperal sepsis, and other blood diseases and blood-forming organs and certain disorders involving the immune mechanism were three main causes of maternal mortalities in this study. Therefore, predicting hemorrhage and preparing to control it, such as rapid access to blood and its products, screening of pregnant mothers with blood diseases and providing them with specialized training and care, as well as paying more attention to postpartum care for at least 42 days after delivery, especially in cases of postpartum hemorrhage and infection, could be effective in preventing more maternal mortality.

کلیدواژه‌ها [English]

  • Etiology
  • International Classification of Diseases
  • Maternal mortality
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