大部分懷孕相關的死亡與心臟有關


  October 22, 2007 (紐奧良) — 根據一篇回溯切片案例分析,懷孕相關的死亡通常是週產期心肌病變(peripartum cardiomyopathy)、子癇前症(preeclampsia)、HELLP症候群(HELLP syndrome)、懷孕脂肪肝以及羊水栓塞(amniotic fluid emboli)的結果。
  
  HELLP是一種發生在孕婦出現溶血(Hemolysis,H)、肝酵素指數過高(Elevated liver enzymes,EL)、血小板不足(Low platelet count,LP)等的症候群;HELLP症候群發生在有子癇前症或者子癲症(eclampsia)的孕婦;如果嚴重,導致血壓以及尿蛋白升高,會發生致命的抽筋。
  
  阿拉巴馬大學病理科住院醫師Amanda Crowe在美國臨床病理學會(ASCP)2007年會的海報組報告中指出,母親死亡是罕見的,其中 58%的案例是因為懷孕或懷孕相關問題導致;42%是因為有其他與懷孕無關的致命併發症。
  
  在作為高風險診所以及治療高風險轉診案例的阿拉巴馬大學醫院的一篇系列案例回溯研究中,對1991年1月1到2007年3月9日之間的4307例報告分析切片結果,探討母親的死亡數與案例,此項研究確認了36件母親死亡案例(佔所有案例的0.8% ),年齡範圍從14到46歲 (平均年紀為 26.2 歲)。
  
  死亡分類為直接與懷孕有關、懷孕是風險因素、手術併發症、與懷孕無關的潛在問題;有12例死亡(33%)是直接與懷孕有關,9例死亡(25%)是與懷孕相關,4例死亡 (11%)是手術併發症引起,11例死亡 (31%)是因為潛在醫療問題。
  
  懷孕相關的死亡是因為週產期心肌病變、子癇前症、HELLP症候群、懷孕脂肪肝以及羊水栓塞等引起,懷孕相關的死亡分類包括肺栓塞、感染、藥物作用,以及主動脈剝離。
  
  手術併發症包括出血、術中死亡、以及食道穿孔。
  
  Crowe醫師表示,潛在問題導致的死亡主要是那些原本就有的狀況,是與懷孕無關的致命醫療問題;她指出,婦產科領域的進步已經使得懷孕期間的母親與胎兒更安全。
  
  未參與此研究的ASCP年會委員會計畫主任,加州大學的Elizabeth Wagar醫師在Medscape病理學的訪談中指出,所有切片中的母親死亡率只有0.8% (共回顧超過4300例切片)。
  
  Wagar醫師指出,現在的健康照護明顯地減少懷孕有關的死亡百分比,19世紀時,每10,000例生產發生約700件死亡,這些死亡有許多是因為生產併發症和感染有關,目前的研究指出,大部分的母親死亡是因為懷孕或與懷孕相關,以及因為既有之與懷孕無關的醫療問題,特別是死亡率與感染併發症無關,這在100年前是母親死亡的主要因素。
  
  Crowe醫師宣稱無相關財經關係。
  
  美國臨床病理學會 2007年會:摘要 2。於2007年10月18日發表。

Majority of Pregnancy-Related<

By Carole Bullock, M.A.
Medscape Medical News

October 22, 2007 (New Orleans) — Pregnancy-related deaths are usually the result of peripartum cardiomyopathy, preeclampsia, HELLP syndrome, fatty liver of pregnancy, and amniotic fluid emboli, according to a retrospective autopsy case analysis.

HELLP is a group of symptoms that occur in pregnant women who have hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). HELLP syndrome occurs in pregnant women with preeclampsia or eclampsia. If severe, it causes elevated blood pressure and protein in the urine and can progress to life-threatening seizures (eclampsia).

"Maternal death is rare, in that only 58% of cases were caused by or strongly associated with pregnancy; 42% of cases had fatal complications that might have occurred in other, nonpregnancy settings," Amanda Crowe, MD, pathology resident, University of Alabama at Birmingham, reported here during a poster session at the American Society for Clinical Pathology (ASCP) 2007 Annual Meeting.

In a retrospective case series from the University of Alabama at Birmingham Hospital, which serves a high-risk clinic and treats high-risk transfers, the number and causes of maternal deaths were determined at autopsy by searching 4307 reports from between January 1, 1991, and March 9, 2007. This search identified 36 cases of maternal death (0.8% of all cases). The age range was 14 to 46 years (mean age, 26.2 years).

Deaths were categorized as conditions seen only in pregnancy, conditions where pregnancy is a risk factor, surgical complications, and underlying conditions not related to pregnancy. Twelve deaths (33%) were caused directly by pregnancy, 9 deaths (25%) were pregnancy associated, 4 deaths (11%) were caused by surgical complications, and 11 deaths (31%) were from underlying medical conditions.

Pregnancy-related deaths were caused by peripartum cardiomyopathy, preeclampsia, HELLP syndrome, fatty liver of pregnancy, and amniotic fluid emboli, whereas deaths in the pregnancy-associated category included pulmonary thromboemboli, infection, drug reaction, and aortic dissection.

Surgical complications included hemorrhage, intraoperative death, and esophageal perforation.

Deaths attributed to underlying conditions were cases in which there were preexisting, potentially fatal medical problems that were not pregnancy related, Dr. Crowe said.

"Advances in the field of obstetrics and gynecology have now made the peripartum period much safer for both mother and child," she added.

Elizabeth Wagar, MD, from the University of California, Los Angeles, and program chair of the ASCP annual meeting committee, who was not associated with the study, noted in an interview with Medscape Pathology that maternal death occurred in only 0.8% of all autopsies (more than 4300 autopsies were reviewed).

"Modern healthcare has clearly reduced the percentages of deaths that are associated with pregnancy. In the 19th century, as many as 700 deaths occurred per 10,000 births. Many of these deaths were related to delivery complications and infection," Dr. Wagar noted. "The present study indicates most maternal deaths were caused by or strongly associated with pregnancy and were due to preexisting medical problems that were not pregnancy related. Notably, mortality was not related to infectious disease complications, a common cause of maternal mortality 100 years ago."

Dr. Crowe has disclosed no relevant financial relationships.

American Society for Clinical Pathology 2007 Annual Meeting: Abstract 2. Presented October 18, 2007.

    
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