2018—2020年河南省危重孕产妇发生情况及影响因素分析

Study on the prevalence of maternal near miss and accosiated factors in Henan Province,2018 to 2020

目的了解2018—2020年河南省危重孕产妇发生情况及其影响因素,为降低危重孕产妇发生率和孕产妇死亡率提供科学依据。方法通过中国危重孕产妇监测网络直报系统,收集河南省32家危重孕产妇监测医院住院分娩的孕产妇信息,采用卡方检验和多因素logistic回归分析危重孕产妇发生的影响因素。结果共监测住院分娩的孕产妇384890例,城市206584例(53.67%),农村178306例(46.33%)。危重孕产妇2047例,发生率为5.32‰,其中城市(7.39‰)高于农村(2.92‰),差异有统计学意义(χ^(2)=178.141,P<0.05);三级医院、二级医院和一级医院接诊的孕产妇中危重孕产妇的比例分别为7.54‰、2.87‰和2.98‰,差异有统计学意义(χ^(2)=180.467,P<0.05)。多因素logistic回归分析显示,婚姻状况(OR=0.581,95%CI:0.422~0.798)、受教育水平(高中/中专OR=0.642,95%CI:0.567~0.727、大学及以上OR=0.619,95%CI:0.545~0.702)、产次(OR=1.243,95%CI:1.117~1.383)、产前检查次数(OR=0.602,95%CI:0.517~0.701)、终止妊娠方式(OR=3.286,95%CI:2.879~3.752)和终止妊娠孕周(OR=0.183,95%CI:0.164~0.203)与危重孕产妇的发生有关(P均<0.05)。结论加强低学历妇女及非婚妇女的生育健康教育,改进孕产妇健康管理,降低早产发生,严格控制剖宫产指征,是降低危重孕产妇发生率的关键。

Objective To evaluate the prevalence of maternal near miss and identify its associated factors in Henan Province from 2018 to 2020,thereby providing a theoretical foundation for strategies to reduce maternal near miss incidents and mortality rates.Methods Data were collected on pregnant and postpartum women admitted to 32 critical maternity monitoring hospitals in Henan province via the China Critical Maternity Monitoring Network direct reporting system.Chi-square tests and multivariate logistic regression analysis were employed to assess the factors influencing maternal near miss.Results A total of 384890 hospitalized pregnant women were monitored,with 206584 cases(53.67%)from urban areas and 178306 cases(46.33%)from rural areas.The incidence of maternal near misses was 5.32‰(2047),with urban areas showing a higher incidence of 7.39‰compared to 2.92‰in rural areas(χ^(2)=178.141,P<0.05).The proportion of critically ill pregnant women admitted to tertiary hospitals,secondary hospitals,and primary hospitals was 7.54‰,2.87‰and 2.98‰,respectively,with statistically significant differences(χ^(2)=180.467,P<0.05).Multivariate logistic regression analysis revealed that factors associated with maternal near miss included marital status(OR=0.581,95%CI:0.422-0.798),educational level(high school or technical school OR=0.642,95%CI:0.567-0.727;university or above OR=0.619,95%CI:0.545-0.702),number of pregnancies(OR=1.243,95%CI:1.1171.383),number of prenatal examinations(OR=0.602,95%CI:0.517-0.701),method of pregnancy termination(OR=3.286,95%CI:2.879-3.752),and gestational age at termination(OR=0.183,95%CI:0.164-0.203)(P<0.05).Conclusions Strengthening the reproductive health education of women with low education and unmarried women,improving the management of maternal health,reducing the occurrence of premature birth,and strictly controlling the indications of cesarean section are the key to reducing the incidence of maternal near miss.