昆明市2011~2020年孕产妇死亡率变化趋势及影响因素分析

Changing trend and influencing factors of maternal mortality in Kunming from 2011 to 2020

目的分析昆明市孕产妇死亡率的变化趋势及其主要影响因素,探讨如何降低孕产妇死亡率、减少孕产妇危重症及濒临死亡孕产妇发生率。方法回顾性分析昆明市2011~2015年(“十二五”期间)与2016~2020年(“十三五”期间)三级妇幼保健网络逐级上报的妇幼卫生年报、孕产妇死亡报告卡、孕产妇死亡调查报告、孕产妇死亡漏报调查资料、病历和围产保健手册及死亡评审材料。结果⑴昆明市孕产妇死亡率从2011年的27.96/10万下降到2020年的6.55/10万(χ~2=581.455,P<0.001);⑵前后5年对比,死亡孕产妇社会人口学特征、围产期保健及就诊分娩情况有明显变化;⑶死亡原因:(1)产科出血、内科合并症、羊水栓塞、心脏病、妊娠期高血压疾病仍是孕产妇死亡的重要影响因素,其死亡专率后五年较前五年均呈下降趋势;(2)子宫收缩乏力仍是直接产科死因的首要因素;(3)猝死是间接产科死因的首要因素;⑷医疗保健机构知识技能问题是可避免死亡的首位影响因素。结论构建围产期保健的安全防线,降低孕产妇死亡率,需要进一步提升群众围产保健意识、加强多学科合作救治、建立产科急救团队以及开展孕产妇危重症评审。

Objective To analyze the changing trend of maternal mortality in Kunming and its main influencing factors,and to explore how to reduce maternal mortality and reduce the incidence of critically ill and dying maternal mortality.Methods A retrospective analysis of the maternal and child health annual report,maternal death report card,pregnancy and child health reports,maternal mortality survey report,maternal mortality underreporting survey data,medical recordsand perinatal care manuals and death review materials reported by the third-level maternal and child health care network in Kunming from 2011 to 2015(the"Twelfth Five-Year Plan"period)and from 2016 to 2020(the"Thirteenth Five-Year Plan"period).Results(1)The maternal mortality rate in Kunming decreased from 27.96/100000 in 2011 to 6.55/100000 in 2020(χ~2=581.455,P<0.001);(2)Compared with the five-year period before and after,the sociodemographic characteristics,peripheral health care and delivery conditions of pregnant and lying-in women who died have changed significantly;(3)Causes of death:(1)Obstetric hemorrhage,medical complications,amniotic fluid embolism,heart disease,and pregnancy-induced hypertension were still important factors for maternal mortality,the mortality rate in the next five years,showed a downward trendcompared with the previous five years;(2)Uterine atony was still the leading cause of direct obstetric death;(3)Sudden death was the leading cause of indirect obstetric death;(4)The problem of knowledge and skills in health care institutions was the first influencing factor of avoidable death.Conclusion To build a safety line of perinatal health care and reduce maternal mortality,it is necessary to further enhance the public awareness of perinatal health care,strengthen multidisciplinary cooperative treatment,establish an obstetric emergency team and carry out maternal critical care evaluation.