Treatment Of Maternal Near Miss In Beijing:a Single-center Retrospective Observational Study

In recent years,along with the development of economy and the progress of medical treatment,maternal mortality has been greatly reduced.Many countries and regions no longer regard maternal mortality as the most important index to measure the level of social health care,while maternal critical complications are still an important factor threatening maternal life and safety.Therefore,attention to critical pregnant women and the strengthening of treatment capacity are gradually put on the agenda.Objective:As one of the top ten municipal rescue centers for MNM in Beijing,the number of high-risk pregnant women is as high as 80%of the total number of pregnant women.We aim to analyze the disease distribution,clinical treatment characteristics and pregnancy outcome of MNM in the hospital.We examined these cases closing to maternal death for sorting out the key links in the treatment process of MNM.Methods:The MNM who were admitted to The Sixth Medical Center of PLA General Hospital in Beijing from 2015-07-01 to 2020-06-30 were taken as the main research object.Through the "Beijing Maternal criticalMedical record report Card" and the relevant data reported to Beijing Maternal and Child Health Network Information system,the basic informations of patients were obtained.And then we searched the digital medical record database of the hospital to collect the general situation and clinical data of all selected research objects.Lastly,we summarized data through Excel table,carried out descriptive statistical analysis,and used SPSS24.0 software to process statistical data.Research contents:The subjects were divided into two groups according to whether they were admitted to ICU or not.The influence of general condition on ICU transfer rate and the difference of disease distribution between the two groups were compared.Results:In this study,a total of 80 critical pregnant women were collected,and the maternal near miss ratio was 6.69/1000LB as well as MNMR fluctuated in(4.09-10.96/1000LB)from year to year.45 cases were included in the ICU group,and the other 35 cases of MNM were included in the obstetrics group.The difference of hospitalization days between the two groups was statistically significant(P=0.005),and the average hospitalization days of the combined treatment group was longer than that of the obstetrics group,and the effect of admission mode on the ICU admission rate was statistically significant(P=0.029),and the ICU admission rate of the patients referred from other hospitals was higher than that of the emergency patients.For different high risk risk assessment levels,the difference in ICU transfer rate between orange and red was statistically significant(P<0.0001),the risk grade was red ICU transfer rate was higher than orange.In addition,the difference of pregnancy termination mode in ICU transfer rate was statistically significant(P=0.016),the ICU occupancy rate of cesarean section termination of pregnancy was higher than that of vaginal delivery.In terms of disease distribution,most of the patients in the two groups were postpartum hemorrhage,followed by hypertensive disorder complicating pregnancy.There was no significant difference in ICU occupancy rate between the two critical pregnant women(X2=0.221,and P=0.638).Conclusion:Postpartum hemorrhage is the main cause of MNM,followed by gestational hypertension,in addition,uterine inertia is the main cause of postpartum hemorrhage.Among all MNM,patients with postpartum hemorrhage or ectopic pregnancy were cured and discharged,while other patients were transferred to other specialties for further treatment or continued followed-up.The establishment of a sound maternal health care system and dynamic monitoring of pregnancy and puerperium is of great significance to ensure maternal safety.The establishment of a three-level referral system to identify high-risk pregnant women beyond treatment capacity can effectively prevent critically ill pregnant women from further deterioration or even turn to death.The establishment of maternal intensive care unit and multipledisciplinary team should be taken as the direction to continue to improve the quality of obstetrical care.