广东省30年孕产妇死亡的变化

Changes in maternal mortality in past 30 years in Guangdong province

目的了解广东省30年内孕产妇死亡及其影响因素的变化，为有针对性地进行干预，降低孕产妇死亡率提供依据。方法采用孕产妇死亡监测资料和评审资料，用SPSS和Epi Info统计软件分析处理数据。结果广东省30年孕产妇死亡率呈下降趋势，1978年全省孕产妇死亡率为142．4／10万，1990下降到88．3／10万。1992～2008年全省监测地区的孕产妇死亡率由32．5／10万下降到2008年的19．5／10万（Χ^2=57．35，P=0．0000〈0．01）。死因分类也发生了变化，产科出血比例下降（Χ^2=18．96，P=0．0002〈0．01），羊水栓塞（Χ^2=8．87，P=0．0310〈0．05）、妊娠合并内科疾病（Χ^2=40．89，P=0．0000〈0．01）比例有上升趋势；死亡孕产妇产前检查的比例平均为41．4％；在家分娩的比例已逐渐减少（Χ^2=40．89，P=0．0000〈0．01）；主要的死亡地点在县级以上医疗机构，在家死亡和在乡镇卫生院死亡的比例下降（Χ^2=39．28，P=0．0000〈0．01；Χ^2=7．34，P=0．0250〈0．05）。在孕产妇死亡评审中，可避免死亡的比例较高，个人因素的影响比例最高；医疗服务因素的影响以乡镇卫生院的比例较高，并且有上升趋势（Χ^2=42．05，P=0．0000〈0．01）。结论广东省30年降低孕产妇死亡工作的成绩归功于干预措施的有效落实。今后全省降低孕产妇死亡的工作重点将是继续加强对服务人群的健康教育，普及固生期保健知识，增强个体的知识技能；同时不断提高乡镇卫生院／县区级医院的服务能力，重点加强在产科出血、羊水栓塞和妊娠合并内科疾病防治方面的能力建设。

Objective To investigate changes in maternal mortality and its influencing factors so as to provide basis for proforming stressive interventions to reduce maternal mortality. Methods The data from Guangdong provincial maternal mortality surveillance and audit were analyzed by SPSS and Epi Info statistic softwares. Results There was a distinct decreasing trend in maternal mortality in past 30 years in Guangdong province. The maternal mortality rate in 1978 was 142.4/100 000, and that in 1990 was decreased to 88.3/100 000. During the year 1992 to 2008, the maternal mortality was decreased from 32.5/100 000 to 19.5/100 000（Χ^2 = 57.35, P = 0. 0000 〈 0.01 ）. As well, causes of maternal death varied, the proportion of obstetric hemorrhage was decreased（Χ^2 = 18.96, P = 0. 0002 〈 0.01 ）, while the proportions of amniotic fluid embolism（Χ^2 = 8.87, P = 0. 0310 〈 0.05 ） and pregnancy associated internal diseases （Χ^2 = 40. 89, P = 0.0000 〈 0.01 ） were increased. The percentage of dead women who received prenatal examination was 41.4% in average. The proportion of delivery at home of pregnant women was declined from 1992 to 2008 （Χ^2 = 40.89, P = 0.0000 〈 0.01 ）. The maternal deaths occurred in county-level and above hospitals, while the proportion of maternal death occurred at home and in town hospitals has been drop from 1992 to 2008（Χ^2=39.28, P = 0. 0000 〈 0.01 ;Χ^2= 7.34, P = 0. 0250 〈 0.05 ）. In maternal death review, most of maternal deaths were avoidable. Individual factors were main influencing factors of maternal death. In medical influencing factors, the proportion of influencing factors from village or township hospitals was higher during 1992 - 2008 （Χ^2 = 42.05, P = 0. 0000 〈 0.01 ） and there was an increasing trend. Conclusion The achievement in reducing maternal mortality in past 30 years in Guangdong province attributes to earriing-out of effective interventions. In the future, the stress in reducing maternal mortality in Guangdong province should be put in strengthening health education for the popullation served, spreading perinatal health care and improving the individual＇ s knowledge and skills. Meanwhile, the service ability of medical workers in village or township hospitals/ county-level or district-level hospitals should be raised, especially in training of ability of medical workers in prevention and treatment of obstetic hemorrhage, amniotic fluid embolism and pregnancy associated internal diseases.