西安市2011-2015年孕产妇死亡评审分析

Review analysis on maternal mortality in Xi'an city from 2011 to 2015

目的回顾西安市2011-2015年孕产妇死亡病例、评审结论和建议,分析探讨孕产妇死亡危险因素,提出干预措施,以便有效控制孕产妇死亡率。方法对5年来西安市孕产妇死亡病例市、区(县)级评审资料进行了系统回顾和分析,研究孕产妇死亡率、死因构成比、顺位、就诊情况的变化、评审结论和建议。结果西安市孕产妇死亡率由17.99/10万降至12.93/10万,死亡原因以妊娠合并症、妊娠期高血压疾病、产后出血、羊水栓塞为主。分娩地点、死亡地点均以县区级以上医院为主,分别占97.67%、79.59%。市级孕产妇死亡评审可避免死亡占33.33%。结论通过5年的工作,西安市孕产妇死亡率得到有效控制。孕产妇死亡原因和顺位以间接产科原因为主,提示对产科安全的管理要向更广泛范围延伸。需要建立产科多学科管理机制,树立"整体观",在孕产期管理中要更加关注孕妇身体整体状况。同时高龄产妇、弱势人群妊娠安全需要得到足够关注和重视。

Objective To review maternal mortality, evaluation conclusions, and recommendations in Xi＇an city from 2011 to 2015, analyze the risk factors of maternal mortality, and put forward intervention measures so as to effectively control maternal mortality. Methods A systematic review and analysis of the evaluation data of maternal mortality in Xi＇an city fi＇om 2011 to 2015 was performed. The changes of maternal mortality rate, causes of maternal death ratio, rank, situations of medical treatment, and evaluation conclusions and sug- gestions were researched. Results The maternal mortality rate in Xi＇an city decreased from 17.98/100 000 to 12.93/100 000, the causes of maternal death mainly included pregnancy complications, hypertensive disorder complicating pregnancy, postpartum hemorrhage, and am- niotic fluid embolism. Delivery place, place of death were dominated by hospitals above county （district） level, accounting for 97.67 % and 79. 59%, respectively. The rate of avoidable death in hospitals at municipal level accounted for 33.33%. Conclusion Through the work from 2011 to 2015, the maternal mortality rate in Xi＇an city had been effectively controlled. The causes of maternal death are mainly due to indirect obstetric reasons, which suggests that the management of obstetric safety should be extended to a wider range. It is necessary to es- tablish a muhidisciplinary management mechanism for obstetrics, a holistic view should be set up, and more attention should be paid to the overall state of pregnant women during pregnancy and puerperium management. At the same time, it is necessary to pay enough attention to safety of pregnancy among the elderly women and the disadvantaged.