2004-2013年佛山市孕产妇死亡相关因素分析

Related factors of maternal deaths in Foshan City,2004-2013

目的了解2004-2013年佛山市孕产妇死亡率和死因的变化趋势及其影响因素。方法采用佛山市孕产妇死亡监测资料,应用χ2检验对2004-2013年佛山市孕产妇死因变化及死亡相关影响因素进行分析。结果 1.2004-2013年佛山市孕产妇死亡率由2004年的34.77/10万降至2013年的10.73/10万,降幅达69.14%,非户籍孕产妇死亡率下降速度明显快于户籍孕产妇。2.2004-2008年直接和间接产科原因孕产妇死亡分别占65.38%和34.62%,2009-2013年直接和间接产科原因孕产妇死亡分别占33.87%和66.13%,不同时间段的直接和间接产科原因孕产妇死亡差异有统计学意义(P<0.001)。孕产妇死因构成中,2004-2008年前三位死因依次为产科出血34.62%、羊水栓塞12.82%和妊娠期高血压疾病10.26%,2009-2013年的死因顺位为静脉血栓形成及肺栓塞17.74%、妊娠合并心脏病11.29%和其他血管疾病及妊娠期高血压疾病各9.68%。3.户籍和非户籍死亡孕产妇相关因素进行分析显示文化程度低、多产、无产检、初入医院级别是乡镇医院为非户籍孕产妇死亡的重要影响因素。孕产妇死亡评审十二格表因素分析,发现2004-2008年孕产妇死亡评审第一、第二因素的三个环节中均以个人家庭因素为主,其次是医疗保健系统因素,2009-2013年则相反,差异均有统计学意义(P值分别是0.009和<0.001)。结论 2004-2013年佛山市孕产妇死亡率呈明显下降趋势,非户籍孕产妇死亡率下降速度明显快于户籍。2004-2013年佛山市孕产妇的死因由直接产科原因转变为间接产科原因,主要死因构成由产科出血、羊水栓塞和妊娠期高血压疾病转变为静脉血栓形成及肺栓塞和妊娠合并心脏病。文化程度低、多产、无产检、初入医院级别为乡镇医院为非户籍孕产妇死亡的重要影响因素。孕产妇死亡评审十二格表因素由个人、家庭的知识技能问题转变为医疗保健系统的知识技能问题。

Objective To investigate the variation trend and influencing factors of maternal mortality and death causes in Fos- han City from 2004 to 2013. Methods Based on maternal death surveillance data in Foushan City during 2004 - 2013, chi square test was used to analyze the variation trend of death causes and its related influencing factors. Results The maternal mortality in Foushan City decreased to 10.37/100,000 in 2013 from 34.77/100,000 in 2004, with the decreasing amplitude of 69.14 %. The decline of maternal mortality of the non- household - registered population was obviously faster than that of the household- registered population. The proportions of maternal deaths attributable to direct obstetrical factors and indirect obstet- rical factors during 2004 2008 were 65.38% and 34.62% respectively, while the proportions during 2009 - 2013 turned to 33.87 % and 66.13 % respectively. There were statistically significant differences in maternal deaths attributable to direct and in- direct obstetrical factors among different time periods （P 〈 0. 001 ）. The top 3 causes of maternal deaths during 2004 - 2008 were obstetrical hemorrhage （34.62 % ）, amniotic fluid embolism （ 12.82 % ） hypertensive disorders in pregnancy （ 10.26 % ）, while the top 3 causes of maternal deaths during 2009 2013 shifted to venous thrombosis and pulmonary embolism （17.74 % ）, heart diseases in pregnancy （11.29%）, and vascular diseases and hypertensive disorders in pregnancy （9.68%）. Analysis of the fac- tors influencing maternal deaths among the household registered and non- household- registered pregnant women showed that low educational level, fecundity, non- antenatal care and receiving medical care firstly in rural hospital were the factors affecting maternal deaths among the non - household - registered pregnant women. The review of 12 - item evaluation form regarding ma- ternal deaths＇ influencing factors showed that the first and second factors affecting maternal deaths during 2004 - 2008 were the individual - family- related problems and medical care system respectively, whereas, the influencing factors during 2009 - 2013 were quite the contrary, with the statistically significant differences （ P 〈 0. 009 and P 〈 0. 001 ）. Conclusions The maternal mortality in Foshan City from 2004 to 2013 show a downward trend, and the decline of maternal mortality of the non - household - registered population is significantly faster than that of the household - registered population. The medical causes of maternal deaths during 2004 - 2013 shift from direct obstetrical causes to indirect obstetrical causes, and the main causes of maternal deaths shift from obstetrical hemorrhage, amniotic fluid embolism and hypertensive disorders in pregnancy to venous thrombosis, pulmonary embolism and heart diseases in pregnancy. Low educational level, fecundity, non- antenatal care and receiving medi- cal care in mra[ hospital are the important factors influencing maternal deaths among the non- household- registered pregnant women. The factors influencing maternal deaths of the 12 - item evaluation form shift from the problem of knowledge and skill about individual and family to the problem of knowledge and skill concerning medical care system.