中国21所医院妊娠合并症预防及治疗措施的使用情况分析

The coverage of preventive and therapeutic interventions related to maternal complications in 21 hospitals in China

目的 分析21家医院妊娠合并症的发生情况及产科干预措施的覆盖率,为评价及改善中国产科服务水平提供依据.方法 调查2010年11月～2011年1月在3省市21家医院分娩的全部产妇,包括危重或死亡孕产妇共13 322例,计算主要妊娠合并症的发生率、产科预防及治疗措施的使用率以及规范治疗指数.结果 产后出血、子痫前期是发生频率最高的妊娠合并症,发生率分别为2.5%和2.1%.硫酸镁治疗子痫的规范指数较低,为71.4%,预防性子宫收缩剂规范治疗指数和治疗性子宫收缩剂规范治疗指数较高,分别达99.7%和96.1%,其中缩宫素是最常用的子宫收缩剂.不同医院间产科干预措施的使用情况存在差异,个别医院治疗性子宫收缩剂规范治疗指数仅为70%.结论 针对产后出血的预防和治疗措施覆盖率较高,但仍存在薄弱医院;进一步规范子痫的治疗过程、推广子痫相关临床指南的应用应成为今后产科工作的重要内容.

Objective To evaluate the burden of pregnancy-related complications and assess the coverage of key maternal health interventions in China. Methods All women who gave birth and experienced maternal near miss or death in 21 hospitals across 3 provinces from November 2010 to January 2011 were included in the survey. The rate of preg- nancy-related complications and the coverage of key maternal health interventions were calculated. Results Postpartum hemorrhage and preeclampsia were the two most frequent complications. The coverage of MgSO4 usage was only 71.4 %. The coverage of prophylactic uterotonic and therapeutic uterotonic was high, with 99. 7 % and 96. 1%, respectively. Oxy- tocin was the most widely used uterotonic. The coverage of interventions differed across hospitals ; the coverage of therapeu- tic uterotonic was lower than 90 % in several hospitals. Conclusion The coverage of essential interventions related to postpartum hemorrhage was high in China. The quality of obstetric care for women with eclampsia needs to be improved.