上海市近十年外来孕产妇死亡情况分析

Analysis on maternal deaths of floating population during recent 10 years in Shanghai

目的:通过对外来孕产妇死亡资料的分析,了解上海市外来孕产妇系统管理中的问题,为提出有效的干预措施以进一步降低孕产妇死亡率提供科学依据。方法:采用回顾性分析的方法,对十年来上海市孕产妇死亡的个案及评审情况进行分析。结果:①上海市活产总数从1996年的83 208例上升到2005年的125 130例,增加50.38%,而外来流动孕产妇活产总数从1996年的16 458例(占总数的19.78%)上升到2005年的63 968例(占总数的51.12%),增加288.67%(近3倍)。②全市孕产妇死亡数从1996年的24例上升到2005年的32例,其中外来流动孕产妇死亡数从9例(占同期死亡总数的37.50%)上升到31例(占同期死亡总数的96.88%)。③十年中上海市孕产妇平均死亡率为26.92/10万(243/902 807),其中本市户籍者为15.58/10万(70/604 419),外来户籍者为57.98/10万(173/298 388),外来孕产妇死亡率为本市户籍者的3.72倍。全市孕产妇死亡率从1996年的28.84/10万下降到2005年的25.57/10万,以本市户籍孕产妇死亡率下降明显(从22.47/10万下降至2005年的1.64/10万),而外来流动人口孕产妇死亡率从54.68/10万下降到48.46/10万。④十年中外来孕产妇死亡以直接产科原因为主(117例,67.63%),前三位死因分别为产科出血(69例,39.88%)、妊娠期高血压综合征(17例,9.83%)、感染(16例,9.25%)。而本市孕产妇死亡以间接原因为主(40例,57.14%),前三位死因依次为出血(9例,12.86%)、羊水栓塞(9例,12.86%)、心脏病及肝病(7例,10.00%)、异位妊娠(5例,7.14%)。⑤死亡的外来孕产妇呈现以下“三低三高”特点:文化程度低(小学以下文化程度者占61.5%);产前检查率低(未接受过产前检查者占64.3%);住院分娩率低(在家分娩者占43.0%)。经产妇比例高(57.0%,怀孕三次以上者占41.6%);计划外生育比例高(59.0%);死亡原因中产科直接原因比例高(59.2%)。结论:上海本市户籍孕产妇死亡率已接近某些发达国家水平,要进一步降低全市孕产妇死亡率,加强对外来户籍孕产妇的保健管理是关键。

Objective： To learn the experience and lessons of systematic maternal health care so as to provide the scientific basis for further reducing maternal mortality rate. Methods： A retrospective study was used to analyze the case history and data of maternal death audit. Results. （1）Total number of live birth was increased from 83 208 in 1996 to 125 130 in 2005, whereas the live birth of floating population was increased from 16 458 to 63 968. （2）Total number of maternal death was increased from 24 in 1996 to 32 in 2005, among them the maternal death of floating population was increased from 9 to 31 respectively. （3）The average maternal mortality rate （MMR） in Shanghai was 26. 92/105 with the local residents of 15.58/105 and floating population of 57.98/105. （4）The main causes of maternal death for floating population were haemorrhage, PIH and infection, whereas the main causes for Shanghai residents were haemorrhage, AFE, heart disease ＆ hepatic disease and ectopic pregnancy. （5）Maternal death of floating population showed following features ： low education, low coverage of prenatal check - up （ 64. 3% without any check - up）, low hospital delivery （ home delivery 43% ）, paragravida accounted for 57%, 59% maternal death of floating population was extra - planning. Conclusion： MMR for Shanghai residents is close to that of the developed countries. The further reduce of MMR in Shanghai depends on the management for floating population.