吉林省2014-2018年孕产妇产科出血死亡相关因素分析

Factors related to maternal death from obstetric hemorrhage in Jilin province,2014-2018

目的了解吉林省2014-2018年孕产妇产科出血死亡的动态变化趋势,分析死亡原因构成及相关影响因素,提出切实可行的干预措施,保障母婴安全。方法通过全省三级妇幼保健网收集2014-2018年41例产科出血死亡孕产妇的监测及评审结果资料,采用描述性统计方法分析孕产妇产科出血死亡原因构成及相关特征,应用线性趋势卡方检验分析孕产妇产科出血死亡率变化趋势。结果5年间吉林省孕产妇死亡148例,其中产科出血死亡41例,占死亡总数的27.7%;孕产妇产科出血死亡原因构成首位为宫缩乏力(36.6%),其次为子宫破裂(22.0%)和软产道裂伤(17.1%);居住农村、高龄、文化程度低、孕产次数多、基层产科技术薄弱等是产科出血死亡的重要原因;评审结果表明孕产妇产科出血死亡病例中97.6%为可避免死亡。结论加强产科人员适宜技术培训;重视生育政策的变化,全面落实母婴安全五项制度是降低孕产妇产科出血死亡的关键措施。

Objective To investigate the dynamic changing trend of maternal death from obstetric hemorrhage in Jilin province from 2014 to 2018,to analyze the constituent ratio of cause of death and related affecting factors and to put forward feasible intervention measures so as to ensure maternal and child safety.Methods The data regarding monitoring and evaluation results of 41 cases of maternal death from obstetric hemorrhage during 2014-2018 were collected from the provincial three-level maternal and child health care network.Descriptive statistical method was used to analyze the cause constituent ratio and related characteristics of maternal death from obstetric hemorrhage.The chi-square test for linear trend was used to analyze the changing trend of maternal mortality rate of obstetric hemorrhage.Results One hundred and forty-eight cases of maternal death occurred in Jilin province during the 5-year period,of which 41 maternal death cases was due to obstetric hemorrhage,accounting for 27.7%of the total deaths.The first cause of maternal death due to obstetric hemorrhage was uterine atony(36.6%),followed by uterine rupture(22.0%)and soft birth canal laceration(17.1%).Dwelling in rural areas,advanced age,low educational level,high number of pregnancies and weak skills in grass-root obstetric care were the important causes of death from obstetric bleeding.The evaluation results indicated that 97.6%of maternal death cases due to obstetric hemorrhage were avoidable.Conclusions Enhancing technical training for obstetric personnel,attaching importance to the changes of fertility policy and fully implementing the five-point system for maternal and infant safety are the key measures to reduce maternal death caused by obstetric hemorrhage.