基于“二胎”再育趋势的产科安全影响因素分析及对策探讨

Analysis of factors influencing safety of department of obstetrics based on the second child policy and investigation of countermeasures

目的通过比较"二胎"政策开放前后经产妇妊娠和分娩结局,探讨如何加强生育第二胎产科质量安全管理。方法收集2013年1月—2015年6月某院产科分娩第二胎的基本数据,进行统计分析。结果 "二胎"政策实施后,经产妇、瘢痕子宫再次妊娠比例呈上升趋势,高龄经产妇占比、妊娠期高血压疾病/糖尿病患病率、早产率、巨大儿/低体质量儿分娩率以及产后出血率显著增高。妊娠期高血压疾病经产妇中新生儿窒息、早产、低体质量儿、产后出血的发生风险增高;妊娠期糖尿病经产妇中早产、低体质量儿、巨大儿的发生风险增高。结论现阶段生育第二胎妇女中,高龄、瘢痕子宫再次分娩、妊娠并发高血压/糖尿病者增多,不良分娩结局风险增加;需对再生育者加强孕前检查、妊娠并发症防治以及重症产科出血、子宫破裂应急管理,保证母婴安全。

Objective To investigate how to improve quality and safety management for the department of obstetrics via comparing pregnant and delivery outcomes in multiparas before and after the implementation of ＂the second child＂ policy. Methods The data on the second child from the department of obstetrics at a hospital between January 2013 and June 2015 were collected and statistically analyzed. Results Since the implementation of ＂the second child＂ policy, the pregnant rate in multiparas and women with scar uterus increased. The ratio of women of advanced reproductive age, incidence rates of gestational hypertension（ G H） and gestational diabetes mellitus（ G D M）, and rates of premature delivery, macrosomia, low birth weight delivery, and postpartum hemorrhage increased significantly. For G H multiparas, risks of neonatal asphyxia, premature delivery, low birth w eight delivery, and postpartum hemorrhage increased. For GDM multiparas, risks of premature delivery,macrosomia, and low birth weight delivery increased. Conclusion C urrently among women who has given birth to the second child, those of advanced reproductive age and with scar uterus, GH, and GDM increase. Poor delivery outcomes also increase. It is necessary to enhance pre-pregnancy examinations for women whow ish to give birth again, prevent pregnancy complications, and improve contingency management for severe obstetric hemorrhages and hysterorrhexis, so as to ensure the safety for mothers and babies.