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首页> 外文期刊>BMC Pediatrics >Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda
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Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda

机译：严重产科并发症引起的死产，新生儿死亡和新生儿未命中病例：乌干达两家转诊医院的前瞻性队列研究

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Background Neonatal near miss cases occur more often than neonatal deaths and could enable a more comprehensive analysis of risk factors, short-term outcomes and prognostic factors in neonates born to mothers with severe obstetric complications. The objective was to assess the incidence, presentation and perinatal outcomes of severe obstetric morbidity in two referral hospitals in Central Uganda. Methods A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, in which all newborns from cases of severe pregnancy and childbirth complications were eligible for inclusion. The obstetric conditions included obstetric haemorrhage, hypertensive disorders, obstructed labour, chorioamnionitis and pregnancy-specific complications such as malaria, anemia and premature rupture of membranes. Still births, neonatal deaths and neonatal near miss cases (defined using criteria that employed clinical features, presence of organ-system dysfunction and management provided to the newborns were compiled). Stratified and multivariate logistic regression analysis was conducted to identify risk factors for perinatal death. Results Of the 3100 mothers, 192 (6.2%) had abortion complications. Of the remainder, there were 2142 (73.1%) deliveries, from whom the fetal outcomes were 257 (12.0%) still births, 369 (17.2%) neonatal deaths, 786 (36.7%) neonatal near misses and 730 (34.1%) were newborns with no or minimal life threatening complications. Of the 235 babies admitted to the neonatal intensive care unit (NICU), the main reasons for admission were prematurity for 64 (26.8%), birth asphyxia for 59 (23.7%), and grunting respiration for 26 (11.1%). Of the 235 babies, 38 (16.2%) died in the neonatal period, and of these, 16 died in the first 24 hours after admission. Ruptured uterus caused the highest case-specific mortality of 76.8%, and led to 16.9% of all newborn deaths. Across the four groups, there were significant differences in mean birth weight, p = 0.003. Conclusions Antepartum hemorrhage, ruptured uterus, severe preeclampsia, eclampsia, and the syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome), led to statistically significant attributable risk of newborn deaths (still birth or neonatal deaths). Development of severe maternal outcomes, the mothers having been referred, and gravidity of 5 or more were significantly associated with newborn deaths.
机译：背景新生儿近遗症的发生率比新生儿死亡的发生率高，并且可以对患有严重产科并发症的母亲出生的新生儿进行危险因素，短期结果和预后因素的更全面分析。目的是评估乌干达中部两家转诊医院严重产科疾病的发生率，表现和围产期结局。方法在2013年3月1日至2014年2月28日之间进行了一项前瞻性队列研究，所有来自严重妊娠和分娩并发症的新生儿均符合纳入标准。产科疾病包括产科出血，高血压疾病，分娩阻塞，绒毛膜羊膜炎和妊娠特定并发症，例如疟疾，贫血和胎膜早破。死产，新生儿死亡和新生儿未命中病例（使用采用临床特征，器官系统功能障碍的存在和提供给新生儿的管理的标准进行了定义）。进行分层和多元逻辑回归分析，以确定围产期死亡的危险因素。结果在3100名母亲中，有192名（6.2％）有流产并发症。在其余的分娩中，有2142例（73.1％）分娩，其中胎儿结局为257例（12.0％）死胎，369例（17.2％）新生儿死亡，786例（36.7％）新生儿未命中和730例（34.1％）没有或极少威胁生命的并发症的新生儿。在新生儿重症监护病房（NICU）入院的235名婴儿中，入院的主要原因是64例早产（26.8％），出生窒息59例（23.7％）和26例呼吸不畅（11.1％）。在235名婴儿中，有38名（16.2％）在新生儿期死亡，其中16名在入院后最初24小时内死亡。子宫破裂导致特定病例的最高死亡率为76.8％，并导致所有新生儿死亡的16.9％。在四组中，平均出生体重存在显着差异，p = 0.003。结论产前出血，子宫破裂，严重先兆子痫，子痫和溶血综合征，肝酶升高，低血小板（HELLP综合征）在统计学上可归因于新生儿死亡（死产或新生儿死亡）的风险。严重的孕产妇结局的发展，母亲已被转诊，以及5名或以上的妊娠率与新生儿死亡显着相关。

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