上海市降低异位妊娠孕妇死亡率的干预措施与效果

Intervention approach and its effect on lowering mortality of ectopic pregnancy in Shanghai

探讨有效的干预措施以降低异位妊娠孕妇死亡率。方法通过对１９８７～１９９５年上海市异位妊娠孕妇的死亡监测和专家评审，针对异位妊娠孕妇致死原因，采取提高对异位妊娠的警惕性，提高诊治技能等卫生行政管理和业务部门共同干预的措施。结果（１）造成异位妊娠孕妇死亡的原因是误诊和就诊过迟；（２）１９８７～１９８９年上海市活产数为５２３２９９例，其中因异位妊娠死亡者２３例，死亡率为４．４０／１０万；落实干预措施后的１９９０～１９９５年上海市活产数为６２５２０６例，其中因异位妊娠死亡者１４例，死亡率为２．２４／１０万，与干预前比较Ｐ＜０．０５；（３）异位妊娠在上海市孕产妇死因顺位中由１９８７～１９８９年的第一位降至１９９０～１９９５年第四位。结论落实卫生行政和业务的共同干预措施可降低异位妊娠孕妇的死亡率。

Objective To explore an effective intervention approach to lower the mortality of ectopic pregnancy. Methods We monitored the mortality of ectopic pregnancy during 1987 1995 in Shanghai and experts' audit, focusing on the causes of death from ectopic pregnancy and combining official administration with intervention approach in medical institutions. Results Misdiagnosis and patient's delay to hospital were the causes of death from ectopic pregnancy. There were 523,299 live births in Shanghai from 1987 to 1989, in which 23 cases died from ectopic pregnancy, with a mortality of 4.40/100,000. After implementing the intervention approach, during 1990 1995, 14 cases of the total 625,206 nancies live birth died from ectopic pregnancy, with a mortality of 2.24/100,000, as compared the two, P <0.05. Accordingly, ectopic pregnancy as the cause of maternal death dropped from the first leading cause to the fourth. Conclusion Intensive health care education in masses, medical staffs' awareness to ectopic pregnancy, and intervention, early hospitalization, early diagnosis and early therapy can lower the mortality of ectopic pregnancy.