| Objective:To evaluate the causes、characteristics and risk factors of near miss maternal at the emergency department(ED)of a comprehensive hospital,improve the diagnostic and treatment skills for the maternal in the ED.Methods:The patients of this retrospective study were collected in the ED of Hangzhou first people’s hospital from January 1,2012 to December 31,2015.The general clinical data were collected,including demographic information(age,marital status,education background,means of transportation etc.),admission reason,history of pregnancy,history of abortion,history of production,antenatal examination number,history of cesarean delivery and outcomes.The patients will be divided into maternal near miss and other maternal according to the international diagnostic criteria.Morbidity of every disease will be analyzed first.Then the composition of the cause of visit the ED was analyzed.Finally,Univarite and Bi-variate logistic regressions analysis were used for multivariate analysis of determinants of maternal near miss.Results:A total of 1044 maternal were enrolled in this study.Of this patients,417(39.94%)were maternal near miss.627(60.06%)were general maternal.Every maternal near miss may merge a variety of disease,the digestive system diseases(15.8%)has a highest morbidity.The cardiovascular system diseases came the second and the endocrine connective tissue disease came the third.The former three were all non-pregnancy directly related diseases.The top three pregnancy directly related diseases leading to the maternal visit the ED were premature rupture of membranes(14.66%)、hydramnios/oligohydramnios(8.33%)、severe preeclampsia(4.41%).The top three non-pregnancy directly related diseases leading to the maternal visit the ED were digestive system disease(23.75%)、respiratory system disease(11.20%)、endocrine connective tissue disease(6.32%).Univarite analysis showed age(P=0.018),educational background(P＜0.001),history of patity(P=0.018),abortion(P=0.011),antenatal examination number(P=0.001)and merge internal and surgical disease during pregnancy(P=0.027)were risk factors of maternal near miss.Bi-variate logistic regressions analysis showed that the independent risk factors with their odds ratio and 95%confidence intervals were:advanced age(P=0.017,OR=1.788,95%CI 1.109-2.881),lower education background(P<0.001,OR=3.794,95%CI 1.986-7.245),multipatity(P=0.015,OR=1.389 95%CI 1.065-1.81)and merge internal and surgical disease during pregnancy(P<0.001,OR=6.713 95%CI 1.307-4.451).Conclusion:The main pregnancy directly related diseases leading to the maternal visit the ED was premature rupture of membranes in this comprehensive hospital.The main non-pregnancy directly related diseases leading to the maternal visit the ED was digestive system disease.Advanced age、lower education background、multiparity and merge internal and surgical disease during pregnancy were the independent risk factors which effected the maternal near miss. |
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