湖南省危重孕产妇发生率及影响因素

Incidence of maternal near miss and its determinants in Hunan Province

目的探讨湖南省危重孕产妇的发生情况及其影响因素。方法采取分层整群抽样方法收集2012年1月-2013年6月对湖南省两家省级机构、一家市级机构、两家县级机构共5家医疗保健机构所有入院孕产妇的医院病历资料,判定是否为危重孕产妇将15 252例孕产妇分为病例组和对照组,采用单因素χ^2检验或Fisher精确概率检验和多因素非条件logistic回归分析危重孕产妇发生的影响因素。结果共获得15 252份有效数据,其中危重孕产妇47例,发生率为3.08‰;危重孕产妇发生原因以产科出血最多,占36.2%;其次为高血压、贫血和感染,分别占29.8%、21.3%和14.9%。孕产妇文化程度高中/中专（OR=2.810）、孕产妇文化程度初中及以下（OR=4.096）;未进行产前检查（OR=2.412）是发生危重孕产妇的危险因素。结论文化水平和产前检查与危重孕产妇发生有关。按照孕产期保健规范进行产前检查,加强对文化程度不高的孕产妇孕期保健知识的宣传,可能是预防危重孕产妇发生的重要措施。

Objective To investigate the epidemic status of maternal near miss and its determinants in Hunan Province so as to provide scientific evidence for reducing maternal mortality. Methods Medical records of pregnant women hospitalized in five hospitals in Changsha City,including two hospitals at provincial level,one at manucipal level and two at county level,during January 2012 and June 2013 were collected by stratified-cluster sampling method. The total of 15,252 pregnant women were divided into the case control and control group according to the diagnosis of maternal near miss. Univariate chi-square test or Fisher＇s exact probability test and multivarate non-conditional logistic regression analysis were used to explore the determinants of maternal near miss. Results Totally,47 maternal near miss cases were identified among the 15,252 pregnant women,with the incidence of 3. 08%. Disorders leading to maternal near miss were in turn hemorrhage（ 36. 2%）,hypertension（ 29. 8%）,anemia（ 21. 3%） and infection（ 14. 9%）. Lower educational level of high school/special secondary school（ OR = 2.810）,of junior high school（ OR = 4.096） and having no prenatal care（ OR = 2.412） were risk factors of maternal near miss. Conclusions Educational level and prenatal care are factors associated with maternal near miss. Following the norms of and disseminating knowledge of maternal prenatal health care among pregnant women with poor education may be important measures to prevent the occurrence of maternal near miss.