从生存到康复：严重孕产妇疾病和产科危重疾病的长期后遗症

摘要(中文译文)

重度孕产妇疾病（SMM）和产科危重症在美国呈上升趋势，并导致了显著的孕产妇健康差异。尽管重度孕产妇疾病的急性并发症已有充分记录，但其长期躯体和社会心理后果仍研究不足。对重度孕产妇疾病（包括产科危重症）的长期后果及改善健康结局的干预措施进行叙述性综述。采用结构化检索策略在PubMed及相关OpenEvidence检索中筛选原始研究和综述文章；对相关文章进行了审阅。重度孕产妇疾病和产科ICU入住与再入院、慢性心血管和肾脏疾病、精神后遗症（包括创伤后应激障碍）、生活质量下降及不良生殖结局的风险增加相关。特定的孕产妇疾病状况，如妊娠期高血压疾病、围产期心肌病、产后出血和围产期子宫切除术，各自具有不同的长期健康风险。包括多学科专科门诊、向初级保健提供者的结构化照护过渡、社会心理筛查与支持以及扩大产后医疗补助覆盖范围在内的干预措施，在改善孕产妇健康结局和减少差异方面显示出前景。然而，实施仍不一致，且需要纵向数据。重度孕产妇疾病的幸存者承受着超越产后时期的显著长期健康负担。需要整体性、多学科的随访模式和扩展的卫生政策举措，以弥补照护缺口并改善长期孕产妇结局。本综述概述了关于重度孕产妇疾病和产科危重症长期后果的文献。

Abstract

Severe maternal morbidity (SMM) and obstetric critical illness are rising in the United States and contribute to striking maternal health disparities. While the acute complications of severe maternal morbidity are well documented, the long-term physical and psychosocial consequences remain understudied. To conduct a narrative review of the long-term consequences of severe maternal morbidity, including obstetric critical illness, and interventions for improving health outcomes. Original and review articles were identified using a structured search strategy in PubMed and relevant OpenEvidence searches; pertinent articles were reviewed. Severe maternal morbidity and obstetric ICU admission are associated with increased risks of hospital readmission, chronic cardiovascular and renal disease, psychiatric sequelae, including posttraumatic stress disorder, reduced quality of life, and adverse reproductive outcomes. Specific maternal morbidity conditions, such as hypertensive disorders of pregnancy, peripartum cardiomyopathy, postpartum hemorrhage, and peripartum hysterectomy, each carry distinct long-term health risks. Interventions including multidisciplinary specialty clinics, structured care transitions to primary care providers, psychosocial screening and support, and expansion of postpartum Medicaid coverage show promise in improving maternal health outcomes and reducing disparities. However, implementation remains inconsistent, and longitudinal data are needed. Survivors of severe maternal morbidity experience significant long-term health burdens that extend beyond the postpartum period. Holistic, multidisciplinary models of follow-up and expanded health policy initiatives are needed to address gaps in care and improve long-term maternal outcomes. This review offers an overview of the literature about the long-term consequences of severe maternal morbidity and obstetric critical illness.

如何引用

Obstetrical & gynecological survey 的其他文献

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