1991至2015年上海市围产儿死亡情况分析

Perinatal death from 1991 to 2015 in Shanghai

目的通过对上海市1991至2015年近25年围产儿死亡个案进行分析,了解围产儿死亡趋势、原因,总结经验,为探索进一步健全围产保健制度提供依据。方法回顾性分析1991至2015年上海市围产儿死亡个案,分析死亡趋势、特征及死因。结果 (1)近25年围产儿死亡率平均为5.97‰,其中户籍人口平均为4.80‰,非户籍人口平均为7.41‰,近25年间围产儿死亡率逐年下降;(2)近25年围产儿死亡以非户籍为主,占55.45%,其母亲产次为2次以上的比例逐年上升,从18.80%升至40.76%,双胎死亡比例逐年缓慢上升,2010年开始超过10.00%,2015年达最高水平13.00%;(3)围产儿死亡中死胎、死产和早期新生儿死亡构成分别为53.35%、8.33%和38.32%,死产死亡构成和新生儿死亡构成逐年下降。死胎率从1991年的4.35‰下降到2015年的1.85‰(χ~2=732.383,P=0.000),死产率从1991年的1.18‰下降到2015年的0.12‰(χ~2=879.183,P=0.000),新生儿死亡率从1991年的4.90‰下降到2015年的1.18‰(χ~2=2 040.316,P=0.000);(4)围产儿死亡原因顺位中前四位分别为早产儿、严重畸形、宫内窘迫和原因不明,其中先天畸形比例占死亡总数的12.63%。结论上海市围产儿死亡率处于中等发达国家水平,与上海市近20年的孕产期保健措施密不可分,为了进一步控制围产儿死亡率,需加强出生缺陷三级预防、提高孕产妇保健精细化管理和人才培养。

Objective To understand the trend and cause of perinatal death by analyzing perinatal death cases in 25 years from 1991 to 2015 in Shanghai and sum up experiences so as to provide evidence for improvement of perinatal health care systme. Methods Cases of perinatal death in Shanghai occurred from 1991 to 2015 were studied. Trend,characteristics and causes of perinatal mortality were analyzed. Results Average perinatal mortality rate（ PMR） in recent 25 years was 5. 97‰,among which PMR of people with Shanghai household registration was 4. 80‰ and that of people without Shanghai household registration was 7. 41‰. PMR had been declined over past 25 years. Perinatal deaths mainly happened in people without Shanghai household registration over past 25 years,accounting for 55. 45% of total. Proportion of died perinatals whose mother had delivered more than 2 times increased from 18. 80% to 40. 76% year by year. Propotion of died perinatals who were twins ascended year by year,which began to exceed 10. 00% in 2010 and reached highest level of 13. 00% in 2015. Percentage of dead fetus,stillbirths and early neonatal death occupied 53. 35%,8. 33% and 38. 32%,respectively in perinatal deaths. Proportion of stillbirths and neonatal deaths had been declined yearly. Fetal death rate had declined from 4. 35‰ in 1991 to 1. 85‰ in 2015（ χ~2 = 732. 383,P = 0. 000）. Stillbirth rate had declined from 1. 18‰ in 1991 to 0. 12‰ in 2015（ χ~2 = 879. 183,P = 0. 000）. Neonatal death rate had declined from 4. 90‰ in 1991 to 1. 18‰ in 2015（ χ~2 = 2 040. 316,P = 0. 000）. Top 4 causes of perinatal death were premature birth,severe malformation,intrauterine distress and unknown causes in turn,and proportion of congenital malformation was 12. 63% in total death. Conclusion PMR of Shanghai is at level of medium developed county,which is closely connected with maternity care measures practised in Shanghai in recent 20 years. In order to further control the PMR,three-level prevention of congenital defects should be strengthened,fine management of maternal health care should be improved and multi-disciplinary professionals should be trained.