中国助产机构严重产后出血发生现状和防治能力

The Current Situatiom,Prevention and Treatment Capabilities of Severe Postpartum Hemorrhage in Chinese Midwifery Institutions

目的:分析我国严重产后出血(SPPH)发生现状、变化趋势和机构变异,以评估我国助产机构SPPH防治能力。方法:研究利用国家医疗质量管理与控制信息网(NCIS)全国助产机构上报的2018~2022年历年医院水平汇总数据。研究纳入上报了2018~2022年产科指标完整数据的助产机构3871、4034、4028、4683和5277家。计算历年全国及不同地区和类别助产机构SPPH(胎儿娩出后24小时内出血量≥1000 ml)率、SPPH并输血率、妊娠相关子宫切除率。利用2022年数据,用P 5和P 95之差描述助产机构上述指标发生率在地区和机构间的变异程度。结果:在纳入的助产机构中,SPPH率、妊娠相关子宫切除率从2018年(0.95%、35.91/10万)到2019年(0.94%、34.18/10万)下降,SPPH并输血率基本平稳(2018年和2019年都为0.62%),但在2020年SPPH率、SPPH并输血率、妊娠相关子宫切除率(0.99%、0.67%、36.34/10万)都上升;随后2021年(0.93%、0.62%、29.00/10万)和2022年(0.90%、0.59%、27.34/10万)3项指标连续两年下降,且都低于2018年水平。2022年数据显示三级(2.86%、1.92%)和二级(2.55%、1.65%)公立综合医院机构间SPPH率、SPPH并输血率变异程度(P 5和P 95之差)最大,西南地区SPPH率(1.30%)、SPPH并输血率(0.73%)、妊娠子宫切除率(39.89/10万)均呈最高水平。结论:我国助产机构SPPH防治能力持续提高,但仍需进一步促进地区和机构间的同质化发展,特别是聚焦西部地区和基层医疗机构能力提升。未来仍需探索SPPH防治的综合管理策略,并在我国孕产妇死亡从产科直接原因逐渐转为产科间接原因为主之际,实施提高医疗服务质量和效率的系统性措施,以保障孕产妇安全。

Objective:To analyze the current situation,changing trends,and institutional variations of severe postpartum hemorrhage(SPPH)in China,in order to evaluate the prevention and treatment capabilities of SPPH in midwifery institutions in China.Methods:We used hospital-level annually aggregated data from hospitals across China's Mainland from the National Clinical Improvement System(NCIS).This study included 3871,4034,4028,4683 and 5277 maternity hospitals that reported complete data of obstetric indicators from 2018-2022.Calculate the SPPH rate(bleeding≥1000 ml within 24 hours after delivery),the SPPH related blood transfusion rate,and pregnancy related hysterectomy rate in different regions and categories of midwifery institutions across the country over the years.Data from 2022 were used to,describe the degree of variation of the above indicators in midwifery institutions across regions and institutions using the difference between P 5 and P 95.Results:Among the included midwifery institutions,the rates of SPPH and pregnancy-related hysterectomy decreased from 0.95%,35.91/100000 in 2018 to 0.94%,34.18/100000 in 2019,but the SPPH related blood transfusion rate remain relatively stable(0.62%)during 2018 and 2019.Subsequently,the rates of SPPH,blood transfusion caused by SPPH,and pregnancy-related hysterectomy increased to 0.99%,0.67%,and 36.34/100000 in 2020 respectively;then decreased again for two consecutive years in 2021(0.93%,0.62%,29.00/100000)and 2022(0.90%,0.59%,27.34/100000),all of which were lower than the levels in 2018.The data for 2022 shows that the SPPH related blood transfusion rate among tertiary(2.86%,1.92%)and secondary(2.55%,1.65%)public comprehensive hospitals have the highest degree of variation(difference between P 5 and P 95),while the SPPH rate(1.30%),SPPH related blood transfusion rate(0.73%),and pregnancy related hysterectomy rate(39.89/100000)in the southwest region are all at the highest level.Conclusions:The SPPH prevention and control capabilities of midwifery institutions in China continue to improve,but further promotion of homogeneous development between regions and institutions is still needed,especially focusing on improving the capabilities of western regions and primary medical institutions.In the future,it is still necessary to explore comprehensive management strategies for the prevention and treatment of SPPH,and to implement systematic measures to improve the quality and efficiency of medical services to ensure the safety of pregnant and postpartum women,as direct obstetric causes gradually shift to indirect obstetric causes in China.