Surveillance Analysis Of Maternal Near Miss In A Single Center From 2013 To 2022

Objective:In this study,the monitoring data of maternal near miss in the First Hospital of Shanxi Medical University from 2013 to 2022 were analyzed to understand the complications and the occurrence of maternal near miss,explore the relevant influencing factors,and provide scientific basis for strengthening the management of maternal near miss and reducing the incidence of maternal near miss.Methods:This study collected the monitoring data of maternal near miss in the First Hospital of Shanxi Medical University from 2013 to 2022,including maternal general condition,pregnancy termination,comorbidity or complications and severe condition.The occurrence of maternal complications,severe maternal complications and ICU admission were analyzed using statistical methods.Data were collated and classified using the Excel form.Statistical analysis was performed using SPSS 26.0,frequency,rate or composition ratio description for count data,x~2 tests were used for comparison between groups,x±s description for measurement data,and ANOVA for inter-group comparisons.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors.The test level was set to=0.05,and P<0.05was considered as a statistically significant difference.Results:1.In this study,40,747 pregnant women were reported by the direct reporting system of the First Hospital of Shanxi Medical University from 2013 to 2022.In the last 10years,27552 people were delivered,with an average of 2755±505 people/year.In the past 10 years,the average age of delivery showed a gradual upward trend(F=100.359,P<0.05),the proportion of delivery among 29 years old showed a decreasing trend year by year,and the proportion of delivery between 30-34 and 35-39 years showed an increasing trend year by year(2=962.601,P<0.05).2.Among 40747 pregnant women,35083 had complications or comorbidities,with an incidence of 86.10%.Complications/complications:the largest number of anemia with an incidence of 30.09%,thyroid disease ranked second with 24.46%,and the third was diabetes with an incidence of 17.82%.3.Results of influencing factors of complications/complications:30-34years old,35-39years old,≥40years old,previous cesarean section,education of high school,junior high school and below,pregnancy 2,3 pregnancy,5 times and more,married and pregnant twins and more are risk factors for complications/complications(P<0.05).4.Among 40747 pregnant women,891 met the WHO criteria,the number of live births was 27873,and the MNMR was 31.97‰.Among 891 maternal near miss,complications:anemia was the largest number of people with an incidence of 66.6%,followed by 429 cases with 48.1%;the third was hypertensive disease with an incidence of 29.0%.The highest incidence of severe maternal coagulation dysfunction was23.3‰,followed by cardiovascular system disorder,with an incidence rate of 7.4‰.5.Analysis of the influencing factors of critical illness:One previous cesarean section,educational level of high school and middle school and below were all risk factors for maternal near miss(P<0.05).The prenatal examination 5 times or more are protective factors(P<0.05).6.Among the 891 maternal near miss,213 were admitted to the ICU,and the ICU transfer rate of the maternal near miss was 23.91%.Among the 213 maternal near miss admitted to ICU,the incidence of coagulopathy was the highest in 4.7‰,followed by cardiovascular system disorder,with an incidence of 3.3‰.The highest used clinical intervention after ICU admission was a transfusion of 5 units or 1000ml of whole blood(54.46%).Conclusion:1.The average age of delivery,the last 10 years,and the proportion of births aged 30-39 years is increasing year by year.2.Maternal complications/comorbidities are successively anemia,thyroid disorders,diabetes,hypertensive disorders and bleeding.3.Delivery age is over 30 years of age,1 number of previous cesarean section,below high school education,more than 2 pregnancies,and multiple pregnancies are risk factors for complications/comorbidities.4.Complications/comorbidities in maternal near miss are anemia,bleeding,hypertension disease,thyroid disease,and thrombocytopenia.5.Previous history of cesarean section and below high school education are all risk factors for severe maternal complications.The prenatal examination 5 times or more are protective factors.6.The main types of severe diseases in maternal near miss are blood coagulation dysfunction,so the prevention and treatment of anemia and hemorrhagic diseases should be strengthened to reduce the utilization rate of blood products.