2016—2019年河南省危重孕产妇监测结果分析

Monitoring results of maternal near miss in Henan Province,2016-2019

目的通过对2016—2019年河南省32家监测医院危重孕产妇监测数据进行分析,了解河南省危重孕产妇发生情况及高危因素,为降低河南省危重孕产妇发生率提供理论依据。方法回顾性分析2016—2019年河南省32家危重孕产妇监测医院通过《孕产妇个案调查表》收集的孕产妇资料,此资料来源于国家危重孕产妇监测医院网络直报系统,分析孕产妇妊娠合并症/并发症发生情况及危重孕产妇发生的高危因素。并采用多因素logistic回归分析危重孕产妇的发生风险。结果2016—2019年河南省32家监测医院共监测孕产妇581358例,妊娠合并症/并发症发生率为47.53%(276325/581358);危重孕产妇发生率为0.46%(2648/581358);有19例孕产妇发生死亡,孕产妇死亡率为3.27/10万。前5位孕产妇妊娠合并症/并发症依次为贫血、合并其他疾病、糖尿病、重度子痫前期、妊娠期高血压。危重孕产妇病因前3位分别为贫血、合并其他疾病、宫缩乏力。经非条件logistic回归分析显示,产次(包括此次分娩)为2次、产前检查次数(不包括此次入院检查)>5次为孕产妇发生危重症的保护因素,而年龄≥35岁、婚姻状况为单身/离异/丧偶/其他、受教育情况为高中/中专及以下、产次(包括此次分娩)≥3次、既往剖宫产次数≥1次、双胎及以上妊娠为孕产妇发生危重症的危险因素。结论高龄、婚姻状况为单身/离异/丧偶/其他、文化水平较低、瘢痕子宫、多次生产(≥3次)及多胎妊娠是河南省孕产妇发生危重症的危险因素。针对高危孕产妇进行科学宣教,对降低河南省危重孕产妇发生率和孕产妇死亡率有一定帮助。

Objective To investigate the occurrence and risk factors of maternal near miss, and to provide theoretical evidence for reducing the incidence of maternal near miss by analyzing the surveillance data in 32 monitoring hospitals in Henan Province from 2016to 2019.Methods Retrospective analysis was used to analyze the surveillance data of maternal near miss collected through the maternal case report form in 32 monitoring hospitals in Henan Province from 2016 to 2019. The data were from the national maternal near miss surveillance system. The occurrence of complication, risk factors of maternal near miss were analyzed by logistic regression.Results There were 581 358 pregnant women monitored in 32 hospitals in Henan Province from 2016 to 2019. The incidence of pregnancy complications and maternal near miss was 47. 53%(276 325/581 358) and 0. 46%(2 648/581 358), respectively. There were 19 maternal deaths and the maternal mortality ratio(MMR) was 3. 27/100 000. The top five complications of pregnancy were anemia, combined with other diseases, diabetes mellitus, severe preeclampsia, and gestational hypertension. The top three causes of maternal near miss were anemia, combined with other diseases and uterine inertia. Logistic regression analysis showed that the number of parturition(including this delivery) being twice, and the number of prenatal care visits(excluding the current hospital visit) > 5were protective factors;age ≥35 years old, marital status being single/divorced/widowed/other, high school education level or below,parity(including current delivery)≥3, number of previous cesarean section≥1, and number of fetuses≥2 were the risk factors of maternal near miss.Conclusion Advanced age, marital status being single/divorced/widowed/other, lower education level, scarred uterus, multiple deliveries( ≥3 times) and multiple pregnancies are the risk factors of maternal near miss in Henan Province.Scientific health education for high-risk pregnant women would be helpful to decrease the incidence of maternal near miss and maternal mortality rate.