农村贫困地区孕产妇死亡情况分析与干预措施研究

Analysis of the Maternity Death Status and Research of Intervention Strategies in the Poor Rural Areas

目的分析造成孕产妇死亡的主要原因及其影响因素,总结项目相关干预经验,探讨进一步有效降低项目地区孕产妇死亡率的干预措施。方法通过对典型个案的回顾性研究,总结分析死亡孕产妇的人口学特征、妇幼保健服务利用以及死亡原因等情况。结果孕产妇于家中分娩者占58.44%,家中和途中死亡者占50.65%;孕产妇死亡前2位死因依次为产后出血、妊娠合并心脏病,直接产科原因占84.41%,其中66.23%的孕产妇死于产后出血;导致产后出血的主要原因为胎盘滞留(35.29%),子宫破裂(17.65%),副胎盘粘连(13.73%)等;死亡对象中计划外生育者占34.00%;社会经济因素对象人口学因素、行为因素和保健服务因素是影响项目地区孕产妇死亡的主要因素。结论要继续实施住院分娩特困救助制度,加大健康教育力度,加强计划外生育管理,建立高危孕产妇应急处理机制,落实村级妇幼保健员的职责与待遇,加强乡镇卫生院产科建设。

OBJECTIVE Analyze the main causes of maternity death and the influencing factors, and sum up the intervention experience, in order to explore intervention strategies to further decrease maternity death rate in MCH project areas. METHODS Through reviewing of representative cases, analyze the demographic traits of maternity death cases, MCH services utilization and the causes, etc. RESULTS 58.44% maternity women deliveried at home, 50.65% pregnant women died at home or on their road to hospital, The two main causing factors of maternity death were postpartum hemorrhage and pregnancy with heart diseases, The direct cause of maternity death accounted for 84.41%, 66.23% of the pregnant women died of postpartum hemorrhage,The main causes of postpartum hemorrhage were placenta resort （35.29%） , uterusbreach （17.65%）, placenta conglutination （13.73%） etc. Of all the maternity death cases, thepregnancies that disobeyed the family planning policy accounted for 34.00%. Social and economic factors, demographic traits of pregnant women, behavioral factors, MCH service are the main influencing factors of maternity death. CONCLUSIONS It＇s demanded to further implement the hospital delivery medical aid system, strengthen the health education, reinforce the management of unplanned pregnancies, establish emergency disposal mechanism aimed at pregnant women with high risks, guarantee the responsibility and income of the village MCH personnel, and reinforce the construction of maternity department in the township health centers.