2004～2014年日照市孕产妇死亡原因分析与对策

Analysis on the causes of maternal death in Rizhao from 2004 to 2014 and the countermeasures

目的：了解日照市孕产妇死亡变化趋势及影响因素,探讨应对措施,为降低孕产妇死亡率,保障母婴健康提供科学依据。方法：通过对2004~2014年国家妇幼信息监测系统和日照市三级妇幼保健网络收集报表及孕产妇死亡病例资料,组织日照市孕产妇死亡评审专家进行评审,明确疾病诊断和死因。采用SPSS13.5对孕产妇死亡率及其死亡因素进行统计分析。结果：日照市孕产妇死亡率从2004年的32.04/10万下降到2014年的10.01/10万,降幅为68.76%,年下降速率为6.25%,经统计学卡方检验,孕产妇死亡率呈下降趋势（P〈0.05）。死因前5位依次为：产科出血、妊娠合并内外科疾病、羊水栓塞、妊娠期高血压疾病、麻醉意外。其中产科出血导致的死亡由2004~2009年的43.8%下降到2010~2014年的15.0%,妊娠合并内科疾病导致的死亡由2004~2009年的25.0%上升到2010~2014年的60.0%（P〈0.05）。结论：日照市近11年孕产妇死亡率整体呈明显下降趋势,2010年后进入平台期。但是,因妊娠合并内外科疾病等间接产科死亡因素呈上升趋势,提示孕产妇死亡控制已面临间接产科死亡因素引起的新挑战,应及时采取策略,调整干预措施。

Objective： To understand the change trend and influencing factors of maternal death in Rizhao, explore the counter- measures, provide scientific basis for reducing maternal mortality and ensuring maternal and infantile health. Methods： Maternal death data was collected from national maternal and child information monitoring system and Rizhao three-level maternal and child health care network from 2004 to 2014, then the data was evaluated by assessment experts of maternal death in Rizhao to define diagnosis and the causes of death. SPSS 13.5 software was used to statistically analyze maternal mortality and causes. Results： Maternal mortality in Rizhao decreased from 32. 04 per 100 000 in 2004 to 10. 01 per 100 000 in 2014, the decreasing amplitude was 68. 76%, the annual decreasing rate was 6. 25% , maternal mortality showed decreasing trend （P〈0. 05 ） . The top five causes of maternal death were obstetrical hemorrhage, preg- nancy combining with internal medicine diseases and surgical diseases, amniotic fluid embolism, hypertensive disorder complicating pregnan- cy （ HDCP）, and anesthetic accident. Maternal mortality induced by obstetrical hemorrhage decreased from 43.8% during 2004-2009 to 15.0% during 2010-2014; maternal mortality induced by pregnancy combining with internal medicine diseases and surgical diseases in- creased from 25.0% during 2004-2009 to 60. 0% during 2010-2014 （P〈0. 05） . Conclusion： From 2004 to 2014, maternal mortality in Rizhao showed significant decreasing trend, then maternal mortality entered into platform period. The proportion of indirect obstetrical factors induced by pregnancy combining with internal medicine diseases and surgical diseases showed increasing trend; the study indicates that ma- ternal death control faces new challenge caused by indirect obstetrical factors, the countermeasures should be taken timely and the interven- tion measures should be adjusted.