| Objective: To understand the clinical characteristics,pathogenic factors,treatment and cause of death of maternal near miss,to improve the success rate for emergency treatment of maternal near miss and reduce the maternal mortality rate.Methods: The clinical data of maternal near miss and maternity death admitted to the Intensive Care Unit(ICU)of Shengjing Hospital affiliated to China Medical University from January 2016 to December 2018 were retrospectively analyzed.According to the disease type,The cases were divided into obstetric complications group,pregnancy combined with basic disease group and other organ comorbidities group,analysis of risk factors,criticality and treatment of each group.In addition,the data of maternal near miss(survival group)and maternity death(death group)were compared.Results:(1)Total Condition:839 cases of maternal were treated in ICU among past three years.14 cases of all were lost to follow-up.ICU transfer rate of maternal was 2.44%(839/34363),accounting for 24.31%(839/3451)of ICU patients meanwhile.ICU success rate of treatment for maternal was 96.36%(795/825),and the mortality rate was3.64%(30/825).The proportion of maternal near miss in ICU was 26.42%(218/825),the incidence of maternal near miss was 0.63%(218/34363).(2)There were 156 cases of obstetric complications(71.6%),35 cases of pregnancy with underlying diseases(16%),and 27 cases of other organ complications(12.4%).The top three incidence of obstetric were:65 cases(29.8%)about obstetric hemorrhage,33 cases(15.1%)about pregnancy-induced hypertension,and 20 cases(9.2%)about pregnancy-related heart disease.(3)Compared with the other groups,the incidence of scar uterus in obstetric complications group was highest(P <0.05).Compared with the other groups,the incidence of multiple pregnancy was highest in the group of other organ comorbidities(P<0.05).Multivariate analysis showed that scarred uterus was an independent risk factor(P <0.05).irregular obstetric examination is an independent risk factor for the group of obstetric complications(P <0.05).(4)There was no statistically significant difference in24-hour APACHE-? scores among the three groups(p> 0.05).After treatment the48-hour APACHE-? scores decreased in all three groups.The 48-hour APACHE-?score in the obstetric complication group was the lowest,and had the best treatment effect(p <0.05).Pregnancy with other comorbidities stayed longest in ICU,with an average(11.0 ± 8.5)d(p <0.05).(5)The incidence of coagulation dysfunction was highest in obstetric complications group(P <0.05),with a large amount of blood transfusion(transfusion volume ?5u),and the highest rate of hysterectomy(P <0.05).Compared to the obstetric complication group,the incidence of respiratory dysfunction and neurological dysfunction in the pregnancy with other organ comorbidities group was higher(P <0.05).The proportion of the application of invasive mechanical ventilation and hemoperfusion was the highest among the three groups(both P <0.05).The incidence of circulatory insufficiency was lowest in the pregnancy-associated basic disease group,and the use of vasoactive drugs was also lowest(P <0.05).There were no significant differences in the incidence of liver and kidney dysfunction and CRRT application between the three groups(P> 0.05).(6)30 cases of maternal deaths in past three years.The main death causes were: 9 cases(30%)died of congenital heart disease or heart valve disease,7 cases died of obstetric hemorrhage(23.4%),and 3 cases died of severe preeclampsia(10 %).Compared to Survivors(maternal near miss),the 24-hour and 48-hour APACHE-II scores were higher in the death group(p <0.05).Multiple organ dysfunction(MODS)occurred in the death group,and the average number of organ dysfunction was(3.3±1.3).The proportion of treatment with invasive mechanical ventilation,vasoactive drugs,and CRRT was significantly higher than that in the survival group(p <0.05).Conclusions: The study found that obstetric complications are the leading cause of maternal near miss,independent risk factor for the uterine scar,often associated with blood coagulation dysfunction,but treatment effect is obvious and the lowest mortality rate.Followed by maternal with underlying diseases,circulatory insufficiency occurs less proportion,strengthen management and law underlying disease check-ups help reduce mortality.Although the incidence of organ comorbidities group is the lowest,the maternal condition is more severe,prone to respiratory and neurological insufficiency,long treatment cycles,and poor prognosis.Therefore,strict screening and proper classification of maternal,can help us better understand the clinical characteristics,and promptly correct maternal organ dysfunction which has important clinical implicationsfor treatment. |
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