上海市1993至2002年孕产妇死亡情况分析

A 10-year study on maternal mortality in Shanghai

目的 通过孕产妇死亡资料的分析 ,总结上海市孕产妇系统管理的经验和教训 ,为进一步降低孕产妇死亡率提供科学的依据。 方法 采用回顾性研究的方法 ,对 1993～ 2 0 0 2年来上海市孕产妇死亡的个案及评审情况进行分析。 结果 10年来上海市孕产妇死亡率平均为 2 6 / 10万(2 2 3/ 85 84 6 7) ,其中本市户籍者为 15 / 10万 (10 0 / 6 6 6 818) ,外来户籍者为 6 4 .2 / 10万 (12 3/1916 4 9) ;10年中孕产妇前 6位死因顺位依次为产科出血、心脏病、妊娠高血压综合征 (妊高征 )、肝病、异位妊娠和羊水栓塞 ;通过加强技术培训及健康教育 ,异位妊娠死亡率从 1993～ 1997年的 2 .0 /10万 (9/ 4 4 4 0 5 4 )降到 1998～ 2 0 0 2年的 1.2 / 10万 (5 / 4 14 4 13) ,但值得关注的是近年的异位妊娠死亡又有上升趋势 ;1993年成立了上海市产科心脏病和肝病诊治中心后 ,妊娠合并心脏病和肝病的死亡率有了明显下降 ,从专家评审结果看 ,本市户籍的孕产妇死亡主要与医疗保健因素尤其是医务人员的知识技能相关 ,而外来人口中的孕产妇死亡则主要与社会各部门的管理及个人家庭因素尤其是知识水平及经济状况有关。 结论 上海本市户籍的孕产妇死亡率已接近一些发达国家的水平 ,要进一步降低全市孕产妇死亡率 。

Objective To determine risk factors for maternal death and to obtain experience for preventive intervention. Methods A retrospective study was performed to analyze data from cases of maternal death audit. Results The average maternal mortality rate (MMR) in Shanghai was 26/100 000,with 15/100 000 in local residents and 64 2/100 000 in floating population;The rank of risky factors causing maternal death in the order:obstetric hemorrhage,maternal cardiac diseases,pregnancy induced hypertension,hepatic diseases,ectopic pregnancy and amniotic fluid embolism(AFE);The incidence of maternal death due to ectopic pregnancy was decreased from 2 0 per 100 000 (1993～1997) to 1 2 per 100 000 (1998～2002);The incidence of maternal death due to cardiac diseases and hepatic diseases had been reduced significantly since the center of diagnosis and treatment for maternal cardiac diseases and hepatic disease established in 1993;The audit showed that the causes of maternal death in local residents were closely related to medical factors especially the knowledge and skill of medical staff,whereas the risky factors in floating population was closely related to their economical status and social administering authority. Conclusion MMR in Shanghai local residents was close to that in developed countries.To further reduce MMR in Shanghai depends on improving floating population administration.