从病历中得到真知——规范产科重症患者评审

Standardized review of severe maternal case—based on in-depth study of medical records

中国在降低孕产妇死亡率(maternal mortality ratio,MMR)方面取得了令世界瞩目的成绩,但随着高龄、妊娠合并症与并发症等高危孕妇增多,产科危重病情变得更加复杂,涉及内科、外科、感染科、肿瘤科等多学科的产科重症病例越来越多。因此,当孕产妇死亡已成为极低概率事件时,仅通过死亡评审已难以全面评价妇幼健康发展现状和产科质量,由此推出了产科重症评审的概念。它是基于病历由多学科专业人员按照一定的评审流程和评审规范对救治的产科重症病例进行全程的回顾性分析、评审,既可作为评价和改善产科服务质量的一种手段,也可作为孕产妇死亡评审的补充。因此,无论是从避免孕产妇死亡的关口前置角度,还是从评价和改善产科质量角度,都需要我们重视并不断规范产科重症孕产妇评审,以尽快向降低MMR并提升孕产妇健康水平和生存质量这一目标靠近。

China has gained globally remarkable achievements in reducing maternal mortality ratio(MMR).However,with the increase of pregnant women at high risk such as senile,pregnancy comorbidity and complications,a growing number of obstetrical severe cases that are more complex and involve a wide range of medical,surgical,infectious,and oncological conditions have been emerging.Therefore,when maternal death has become a very low probability event,it is no longer applicable to comprehensively evaluate the current status of maternal and child health development and the quality of obstetrics by using only maternal death review.Under such circumstances,Severe Maternal Case Review has been implemented.Severe Maternal Case Review presents to be a full retrospective analysis and a review of critical cases treated based on medical records by multidisciplinary professionals in accordance with certain review processes and specifications.As a means of evaluating and improving the quality of obstetric services,it also appears to be a supplementation to Maternal Death Review.Therefore,whether it is from the perspective of avoiding maternal deaths beforehand or from the perspective of evaluating and improving the quality of obstetric services,Severe Maternal Case Review needs constant attention and standardization,in order to move forward as soon as possible to the goal of lowering the MMR and improving the level of maternal health and quality of survival.