| ObjectiveThrough the study on the current situation of the treatment of referred maternal admitted to the obstetrics department of Shaanxi Provincial people’s Hospital in the past three years,the advantages and disadvantages of referral and treatment were found,in order to provide a possible basis for optimizing the referral process,and finally improve the maternal treatment rate.reduce maternal mortality.MethodsThe complete data of maternal cases referred to our hospital from January 1,2018 to December 31,2020 in the Department of Obstetrics of Shaanxi Provincial people’s Hospital were collected,including age,marriage,occupation,current address,gestational weeks before transfer,times of pregnancy,times of parturition,previous times of cesarean section,regular antenatal examination,total length of stay in hospital,admission to intensive care unit,multi-disciplinary team,maternal outcome and perinatal outcome,transport related data,and so on.The data were analyzed by SPSS 23.0statistical software,the measurement data were expressed by mean ± standard deviation((?) ±s)or median and range,and the counting data were expressed by percentage.One-way ANOVA,Chi-square test or Fisher test were carried out.Unconditional Logistics regression analysis was used to analyze the relationship between suspicious factors and maternal near miss.P < 0.05 indicates that it is statistically significant.Results1.From January 1,2018 to December 31,2020,1548 maternal were referred from other hospitals or families to our hospital with complete data.Among them,there were 295 maternal near miss and 1 maternal death.Among the maternal referred,the incidence of maternal near miss was 19.06%,and the near miss mortality ratio was 295%.2.maternal transferred out of the hospital are mainly secondary hospitals,accounting for 67.76%,followed by tertiary hospitals,accounting for 24.29%,private hospitals accounting for 4.26%,and direct transportation by home accounting for 3.68%.There were differences in the rate of maternal near miss and the rate of admission to intensive care unit among the maternal referred by different grades of hospitals,but there was no difference in the rate of multi-disciplinary team.163 cases(10.34%)were referred from Xianyang and Ankang areas of Shaanxi,1350 cases(87.21%)from other areas of Shaanxi,and 35 cases(2.26%)from other provinces.3.Among the causes of referral,the top 5 maternal related diseases were hypertensive disorder complicating pregnancy and related complications,postpartum hemorrhage and hemorrhagic shock,pregnancy complicated with hematological diseases,prenatal hemorrhage and hemorrhagic shock,and placental related diseases.Among them,gestational hypertension and related complications were found in 292 cases(18.86%),followed by postpartum hemorrhage and hemorrhagic shock in 114 cases(7.36%),and pregnancy complicated with hematological diseases in 93 cases(6.01%).4.Of the 1548 referrals,1336 were prenatal patients,accounting for86.30%.212 cases(13.70%)were postpartum or postoperative patients with ectopic pregnancy.Among the 1548 patients who were referred to the hospital,1368 patients improved when they were discharged,1 patient died within 24 hours after admission(the pregnancy was not terminated at the time of death),and the other 179 patients were automatically discharged,transferred to hospital or transferred to hospital for their own wishes or disease reasons.Of the 1336 prenatal referrals,1029 cases were terminated in our hospital,306 continued pregnancy and 1 mother died.1029 cases of pregnancy were terminated in our hospital,and 715 cases were terminated by cesarean section,accounting for 69.48%.The fetal outcomes of 1029 cases of termination of pregnancy in our hospital were as follows: 298 full-term newborns(28.96%),461 premature infants(44.80%),54 twins and multiple births(5.25%),perinatal death 216 cases(20.99%).Among the live births,521 cases(64.08%)were transferred to neonatal pediatrics for further treatment.Of the 1548 patients,58 were referred more than 2 times.5.Among the 295 maternal near miss,the first three diseases were blood /coagulation,cardiovascular and respiratory system.There was no significant difference in the incidence of maternal near miss and the rate of admission to intensive care unit in different years.6.Analysis of the factors influencing the maternal near miss of referred maternal,the results showed that there were differences in the incidence of critical pregnant women among different maternal age,marital status,gestational weeks,parturition times,previous times of cesarean section,referral area,referral hospital grade,doctor’s order referral and referral traffic.Further analysis showed that age,marital status,gestational week of referral,grade of referral hospital,referral traffic and doctor-ordered referral were the influencing factors of critical pregnant women.Conclusions1.The maternal mortality of referral maternal was lower,but the incidence rate of maternal near miss was higher,and the maternal near miss ratio of referral maternal was 295: 1,indicating that our hospital has outstanding ability to treat referred maternal.2.The first three causes of maternal related diseases were hypertensive disorder complicating pregnancy and related complications,postpartum hemorrhage and hemorrhagic shock,pregnancy complicated with hematological diseases.According to the order of the disease,we can formulate a targeted referral process and training in diagnosis and treatment of related diseases,so as to improve the efficiency of referral and the level of treatment.3.It is suggested that women should be less than 35 years old and have stable marital status,at the same time,they should pay more attention to pregnancy and family planning after learning related knowledge,and do a good job in pre-pregnancy,mid-pregnancy and postpartum examination,early detection of possible influencing factors of pregnancy,further reduce maternal mortality,so as to ensure maternal and infant safety. |
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