Nationwide confidential enquiries into maternal deaths because of obstetric hemorrhage in the Netherlands between 2006 and 2019.

Autor: Ramler PI; Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.; Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands., Beenakkers ICM; Department of Anesthesiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands., Bloemenkamp KWM; Department of Obstetrics, Birth Center, Wilhelmina Children's Hospital Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands., Van der Bom JG; Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands., Braams-Lisman BAM; Department of Obstetrics and Gynecology, Tergooi Hospital, Blaricum, the Netherlands., Cornette JMJ; Department of Obstetrics and Gynecology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands., Kallianidis AF; Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands., Kuppens SMI; Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands., Rietveld AL; Department of Obstetrics and Gynecology, Amsterdam VU University Medical Center, Amsterdam, the Netherlands., Schaap TP; Department of Obstetrics, Birth Center, Wilhelmina Children's Hospital Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands., Schutte JM; Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, the Netherlands., Stekelenburg J; Department of Health Sciences, Global Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.; Department of Obstetrics and Gynecology, Leeuwarden Medical Center, Leeuwarden, the Netherlands., Zwart JJ; Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands., Van den Akker T; Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands.; Athena Institute, Faculty of Science, VU University, Amsterdam, the Netherlands.; National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Jazyk: angličtina
Zdroj: Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2022 Apr; Vol. 101 (4), pp. 450-460. Date of Electronic Publication: 2022 Mar 02.
DOI: 10.1111/aogs.14321
Abstrakt: Introduction: Obstetric hemorrhage-related deaths are rare in high income countries. Yet, with increasing incidences of obstetric hemorrhage in these countries, it is of utmost importance to learn lessons from each obstetric hemorrhage-related death to improve maternity care. Our objective was to calculate the obstetric hemorrhage-related maternal mortality ratio (MMR), assess causes of obstetric hemorrhage-related deaths, and identify lessons learned.
Material and Methods: Nationwide mixed-methods prospective case-series with confidential enquiries into maternal deaths due to obstetric hemorrhage in the Netherlands from January 1, 2006 to December 31, 2019.
Results: The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 was 0.7 per 100 000 livebirths and was not statistically significantly different compared with the previous MMR of 1.0 per 100 000 livebirths in 1993-2005 (odds ratio 0.70, 95% confidence interval 0.38-1.30). Leading underlying cause of hemorrhage was retained placenta. Early recognition of persistent bleeding, prompt involvement of a senior clinician and timely management tailored to the cause of hemorrhage with attention to coagulopathy were prominent lessons learned. Also, timely recourse to surgical interventions, including hysterectomy, in case other management options fail to stop bleeding came up as an important lesson in several obstetric hemorrhage-related deaths.
Conclusions: The obstetric hemorrhage-related MMR in the Netherlands in 2006-2019 has not substantially changed compared to the MMR of the previous enquiry in 1993-2005. Although obstetric hemorrhage is commonly encountered by maternity care professionals, it is important to remain vigilant for possible adverse maternal outcomes and act upon an ongoing bleeding following birth in a more timely and adequate manner. Our confidential enquiries still led to important lessons learned with clinical advice to professionals as how to improve maternity care and avoid maternal deaths. Drawing lessons from maternal deaths should remain a qualitative and moral imperative.
(© 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
Databáze: MEDLINE
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