洛阳市生育政策调整前后孕产妇死亡监测情况分析

Analysis of monitoring of maternal mortality before and after adjustment of fertility policy in Luoyang

目的分析洛阳市生育政策调整前后孕产妇死亡率和死因变化特点,评价相关的干预措施。方法回顾性分析洛阳市在生育政策调整前后(2013~2018年)孕产妇死亡病例资料。结果生育政策调整初期洛阳市活产数及产妇数呈上升趋势。2016~2017年增长尤为明显,在短期出现了生育高峰,但在2018年出现了明显下降。洛阳市孕产妇死亡率在政策调整前为16.44/10万,政策调整后下降为9.55/10万,差异有统计学意义(P<0.05)。死亡病因中直接产科因素所占比例下降,间接产科因素所占比例升高。评审结果可避免死亡的主要影响因素为个人、家庭因素及医疗保健系统因素。生育政策调整前以医疗保健系统为主要影响因素,而生育政策调整后主要以个人、家庭因素为主要影响因素,生育政策调整前后比较差异有统计学意义(P<0.05)。结论生育政策调整初期,洛阳市出现生育小高峰;孕产妇死亡率整体呈下降趋势,这与洛阳市采取多种措施,提高危急重症孕产妇的救治率有关;生育政策调整后可避免死亡中的个人、家庭影响因素所占比例增大,应加强健康教育宣传,提高育龄妇女健康意识,做好孕产妇围产期保健。

Objective To analyze the changes in maternal mortality and causes of death before and after the adjustment of fertility policy in Luoyang, and evaluate related interventions.Methods Retrospective analysis of maternal mortality data before and after the adjustment of the fertility policy(2013~2018) in Luoyang.Results At the beginning of the adjustment of the fertility policy, the number of live births and maternal births in Luoyang were on the rise.The growth was particularly significant in 2016~2017, with a baby boom in the short term but a significant decline in 2018.The maternal mortality rate in Luoyang was 16.44/100 000 before and 9.55/100 000 after the policy adjustment, showing a statistically significant difference(P<0.05).The proportion of direct obstetric factors in the cause of death decreased, while the proportion of indirect obstetric factors increased.The main factors influencing the outcome of the evaluation were individual, family and health care system factors.Before the adjustment of the fertility policy, the medical care system was the main influencing factor, while after the adjustment of the fertility policy, the individual and family factors were the main influencing factors.The difference between the two before and after the adjustment of the fertility policy was statistically significant(P<0.05).Conclusion At the beginning of the adjustment of the fertility policy, a small peak appeared in Luoyang;the overall maternal mortality rate is on the decline, which is related to the measures adopted by Luoyang City to improve the treatment of critically ill pregnant women.After the adjustment of fertility policy, the proportion of individual and family factors that can prevent death is increasing.We should strengthen health education and publicity, raise the health awareness of women of childbearing age, and provide good perinatal health care for pregnant and lying-in women.