背景:不安全堕胎导致的孕产妇死亡在全球范围内继续发生,撒哈拉以南非洲的堕胎率特别高,那里大多数堕胎被归类为不安全。孕产妇死亡审查是在堕胎仍然非法的情况下防止未来死亡的一致战略的有效组成部分。
目的:本研究旨在对研究期间不安全流产后发生的所有死亡进行孕产妇死亡回顾。为了评估可预防性,并综合可能有助于防止未来不安全堕胎后孕产妇死亡的关键学习要点。
方法:研究中心(乌干达市区的一家国家转诊医院)的所有孕产妇死亡病例(2016年1月至2018年12月为350例)的全案回顾由经过专门培训的多学科产科医生和助产士小组进行。我们提取了不安全堕胎后死亡的妇女的评论(13[2.6%])以进行进一步分析。
结果:发现大多数因不安全流产导致的孕产妇死亡是可以预防的。审查中提出的主要建议是(1)在发生不安全堕胎的情况下,临床医生应保持对延迟就诊和快速代偿失调的高度怀疑,(2)应采用低阈值的早期静脉抗生素治疗,(3)不安全流产后出现并发症的任何入院都应由经验丰富的临床医生尽快进行审查。
结论:堕胎后护理是基本紧急医疗护理的一部分,应高标准提供,特别是在合法获得堕胎护理的机会有限或没有的地区。即使在低资源产科环境中,实施推荐的学习点也可能是可行的,鉴于不安全堕胎导致的孕产妇死亡的可预防性比率很高,可能是有效的。
BACKGROUND: Maternal deaths from unsafe abortion continue to occur globally, with particularly high rates in Sub-Saharan Africa where most abortions are classified as unsafe. Maternal death reviews are an effective part of cohesive strategies to prevent future deaths while abortion remains illegal.
OBJECTIVE: This study aimed to conduct maternal death reviews for all deaths occurring following unsafe abortion during the study period, to assess preventability, and to synthesize key learning points that may help to prevent future maternal deaths following unsafe abortions.
METHODS: Full
case reviews of all maternal deaths (350 cases from Jan 2016 to Dec 2018) at the study center (a national referral hospital in urban Uganda) were conducted by specially trained multidisciplinary panels of obstetricians and midwives. We extracted the reviews of women who died following unsafe abortions (13 [2.6%]) for further analysis.
RESULTS: Most maternal deaths owing to unsafe abortion were found to be preventable. The key recommendations that emerged from the reviews were (1) that clinicians should maintain a high index of suspicion for delayed presentation and rapid decompensation in cases where unsafe abortion has occurred, (2) that a low threshold for early intravenous antibiotic therapy should be applied, and (3) that any admission with complications following an unsafe abortion merits review by an experienced clinician as soon as possible.
CONCLUSIONS: Postabortion care is part of essential emergency medical care and should be provided with high standards, especially in areas where there is limited or no legal access to abortion care. Implementing the recommended learning points is likely to be feasible even in low-resource obstetrical settings and, given the high rates of preventability found in maternal deaths owing to unsafe abortion, is likely to be effective.