بررسی عوارض شدید مادری در مادران نزدیک به مرگ در بیمارستان شهید مصطفی خمینی تهران: 98-1394

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانش‌آموخته پزشکی، دانشکده پزشکی، دانشگاه شاهد، ایران.

2 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران.

3 استادیار گروه آموزش، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران.

4 استادیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه شاهد، تهران، ایران.

چکیده

مقدمه: برای ارزیابی بهتر کیفیت مراقبت­های مامایی از یک شاخص به نام مادران "نزدیک به مرگ" مادرانی که به‌خاطر عوارض بارداری یا زایمان تا پای مرگ رفته، اما نجات پیدا کرده‌اند، استفاده می‌شود. مطالعه حاضر با هدف بررسی شیوع و علل عوارض شدید مادری و مادران نزدیک به مرگ انجام شد.
روش­‌کار: این مطالعه گذشته‌نگر در بیمارستان شهید مصطفی خمینی بر روی پرونده بیماران بستری از سال 98-1394 انجام شد. متغیرهای مورد نیاز شامل اطلاعات دموگرافیک و عوارض شدید بارداری از پرونده بیماران بر اساس دستورالعمل سازمان جهانی بهداشت استخراج و با استفاده از نرم‌افزار آماری SPSS (نسخه 25) و آزمون‌های کای دو و من‌ویتنی مورد تجزیه و تحلیل قرار گرفتند. 05/0≥p معنی‌دار در نظر گرفته شد.
یافته­ها: از 16527 زایمان، 191 نفر دچار عوارض شدید مادری شدند که از این تعداد، 35 نفر (3/17%) نزدیک به مرگ و 2 مورد مرگ مادری وجود داشت. نسبت پیامد شدید مادری 40/11 و نسبت مادران نزدیک به مرگ 09/2 بود. مهم‌ترین علل عوارض شدید به‌ترتیب پره­اکلامپسی شدید (134 نفر؛ 15/70%)، خونریزی شدید مامایی (23 نفر؛ 4/12%) و سپسیس (10 نفر، 23/5%) بود. در موارد نزدیک به مرگ مادری، 19 نفر (94/9%) به اختلال انعقادی، 9 نفر (71/4%) به اختلال قلبی- عروقی و 8 نفر (18/4%) به اختلال کلیوی مبتلا شده بودند. بر اساس نتایج آزمون رگرسیون لوجستیک بین آنمی (01/0=p) و پره­اکلامپسی شدید (006/0=p) با مادران نزدیک به مرگ و عوارض شدید ارتباط معنی‌داری وجود داشت.
نتیجه­گیری: مداخلات زایمانی ضروری شامل مدیریت پره‌اکلامپسی- اکلامپسی و عوارض آن و اهمیت به آنمی مادران هنگام بستری، در کاهش عوارض شدید مادری نقش حیاتی دارند.

کلیدواژه‌ها

عنوان مقاله [English]

Severe maternal complications in near missed mothers in Shahid Mostafa Khomeini Hospital- Tehran: 2015-2019

نویسندگان [English]

  • Masoumeh Aghabozorgi 1
  • Farahnaz Torkestani 2
  • Zahra Jouhari 3
  • Maryam Rabiee 4
1 Medical graduate, Faculty of Medicine, Shahed University, Tehran, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahed University, Tehran, Iran.
3 Assistant Professor, Department of Education, Faculty of Medicine, Shahed University, Tehran, Iran.
4 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahed University, Tehran, Iran.
چکیده [English]

Introduction: To better evaluate the quality of midwifery care, an index called "near miss" mothers is used. The term refers to the mothers who have gone near to death due to complications of pregnancy or childbirth, but survived. This study was performed with aim to investigate the prevalence and causes of severe complications of maternal and near miss mothers.
Methods: This retrospective study was performed on patients' records in Shahid Mostafa Khomeini Hospital from 2015-2016. The required variables including demographic information and severe pregnancy complications were extracted from patients' records according to the instructions of the World Health Organization. Data were analyzed using SPSS statistical software (version 25) and paired chi-square and Mann-Whitney tests. P≤0.05 was considered statistically significant.
Results: Among 16,527 live births, 191 mothers suffered from severe maternal complications, of which 35 (17.3%) had near-miss and 2 maternal death. The ratio of near-miss mothers was 2.09 and the ratio of severe maternal complications was 11.40. The most important causes of severe complications were severe preeclampsia (n=134, 70.15%), severe obstetric bleeding (n=23, 12.4%) and sepsis (n=10, 5.23%). In cases of near-missed mothers, 19 cases (9.94%) had coagulation disorders, 9 (41.71%) had cardiovascular disorders, and 8 (4.18%) had kidney disorders. According to the results of logistic test, a significant relationship was found between anemia (p = 0.01) and severe preeclampsia (P = 0.006) in near-miss mothers and severe complications.
Conclusion: Essential delivery interventions including management of preeclampsia-eclampsia and its complications and the importance of maternal anemia during hospitalization play a vital role in reducing severe maternal complications.

کلیدواژه‌ها [English]

  • Complication
  • Near miss
  • Pregnancy

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مجله زنان، مامایی و نازایی ایران
دوره 24، شماره 12
بهمن 1400
صفحه 16-28

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