Dynamic analysis of critical maternal complications in tertiary hospitals in Wuxi: A study based on four years of monitoring data

by Ye Xu, Peimin Hua, Ye Shen

Severe maternal morbidity (SMM) is a significant public health concern. This study analyzed the incidence, trends, causes, and pregnancy outcomes of SMM in Wuxi to inform future clinical and public health strategies.

A retrospective analysis was conducted on 315 critical maternal cases identified from 156,435 deliveries in Wuxi between October 1, 2020, and September 30, 2024. Data were extracted from a citywide near-miss maternal surveillance system. Statistical analyses were performed using SPSS 25.0, employing chi-square tests and Cochran-Armitage trend tests to evaluate trends, and chi-square tests for comparisons between groups.

The overall incidence of SMM was 0.20%. Initially, this rate remained stable at 0.19% across the first three cycles (P > 0.05); however, it significantly increased to 0.24% during the cycle from October 2023 to September 2024 (χ² = 5.24, P = 0.02). This increase was closely associated with a rise in the proportion of women of advanced maternal age (≥35 years), which reached 26.03% (χ² = 11.76, P = 0.001). Over time, the distribution of risk levels shifted. Initially, the high-risk group was dominant (63.29%), but in recent cycles, the moderate-risk group became more prominent (64.44%). The moderate-risk group was associated with a higher rate of adverse outcomes (25.00–25.71%) compared to the high-risk group (17.11–20.69%; χ² = 10.83, P = 0.01). Direct obstetric factors were the primary causes, accounting for 79.05% of cases, with obstetric hemorrhage being the most prevalent (53.97%). In contrast, the proportion of cases attributable to indirect obstetric factors increased from 17.81% to 26.67%, primarily due to heart disease and infectious diseases.

Improving maternal safety involves dynamic risk assessments, tiered referrals for moderate-risk pregnancies, better multidisciplinary management of complications, optimized emergency responses in primary care, and refined regional referral systems to reduce preventable SMM and mortality.

The Relationship Between Occupational Stressors and Resilience Among Emergency Department Nurses: A Multicenter Cross‐Sectional Network Analysis

ABSTRACT

Background

The global nursing shortage poses a critical challenge to healthcare systems. Emergency department (ED) nurses face high occupational stress due to demanding environments and strained patient-family interactions. Chronic stress impairs resilience and health, contributing to burnout and attrition. Understanding ED nurses' stressors and resilience is vital for workforce stability.

Aims

To identify core elements and interrelationships of occupational stressors and resilience among ED nurses in Zhejiang Province, China, using network analysis, and to explore intervention strategies.

Design

Cross-sectional study.

Methods

From November 2024 to January 2025, data were collected from 990 ED nurses in 26 hospitals across 11 cities. Measures included a demographic questionnaire, the Chinese version of the Stressor Scale of Emergency Nurses, and the Resilience Structure Scale for Healthcare Professionals. Network analysis was conducted to illustrate the interconnections between stressors and resilience factors, while accounting for significant sociodemographic covariates.

Results

A total of 990 nurses participated in the study. Violence-related stressors, such as physical assault and witnessing aggression, were the most prominent nodes in the stressor network. Key resilience elements included reframing patient or family criticism positively and timely emotional regulation. Bridge analysis highlighted ‘viewing criticism as encouragement’ as a crucial link connecting stress and resilience.

Conclusion

ED nurses work under intense stress from violence and scrutiny, which undermines resilience. Strengthening key resilience factors—especially cognitive reframing and emotional regulation—may buffer stress and enhance coping. Bridge nodes offer targeted points for intervention.

Patient or Public Contribution

None.

Impact

This study clarifies the network of occupational stressors and resilience in ED nurses, identifying key intervention targets. It supports interventions focusing on cognitive adjustment, emotional regulation and interpersonal support to build resilience and reduce stress.