1993～2008年中国育龄妇女孕产期保健服务利用趋势分析

目的:描述中国1993～2008年代表不同社会经济发展程度的地区类型已婚育龄妇女产前、产时和产后保健利用的变化情况,并探讨其中存在的问题。方法:通过卫生部发布的1993、1998、2003、2008年4次国家卫生服务调查报告中的有关数据,筛选部分关键指标分地区类型、分时段反映15～49岁已婚育龄妇女孕产期保健服务利用水平的变化和其中存在的问题。结果:在1993-2008年间,孕早期检查率、产前检查率、住院分娩率和产后访视率分别从37.0%、69.5%、38.7%和46.0%升至65.2%、94.4%、88.6%和55.6%,剖宫产率从2.35%增至27.20%;产前保健、产时保健和产后保健各项指标的城乡差别均有不同程度缩小;2008年4类农村地区住院分娩率仅为64.30%,大城市剖宫产率高达63.00%。结论:中国孕产期保健服务利用水平在过去十余年间有了较大提高,但孕早期检查和产后访视两项指标仍处于较低水平。多数指标之间的城乡差距不断缩小,但4类农村地区住院分娩率还不理想。剖宫产率在全国范围内迅速攀升,已经远远超过正常水平,需予以重视和适当引导。     

孕产妇保健服务利用现状调查

目的了解中国孕产妇保健服务需求和利用现状,探讨影响孕产妇保健服务利用的主要因素。方法应用自行设计的调查问卷对2009年7-12月间分娩的1 945名妇女进行调查,并对孕产妇保健服务利用的影响因素进行分析。结果孕早期系统保健管理卡建卡率为49.77%,产前保健指导率为82.98%,产后保健指导率为52.75%,产前检查率为99.33%,产前检查5次率为74.24%,住院分娩率为98.61%,产后访视率为42.21%,产后访视3次率为9.51%;影响孕产妇保健服务利用的因素主要有孕产妇年龄、职业、文化程度、就医距离、活产生育数、居住地以及婚姻状况等。结论孕产妇首次产前检查时间滞后,产后访视率低,孕产妇的孕期保健服务有待加强。     

不同受教育程度早产妇女产前保健利用的 公平状况及其变化

目的 了解早产妇女产前保健利用的公平性及其变化.方法 研究对象为1995-2000年江苏省和浙江省4县(市)分娩孕满28～41周的单胎活产儿的97 537名妇女,根据受教育程度,分别将早产妇女(4994名)和对照妇女即足月产妇女(92 543名)进行分组后,考察其孕早期检查率、产前检查次数达标率、住院分娩率及其率差(RD)、率比(RR)和集中指数(CI),分析早产妇女的产前保健利用的不公平程度,采用单因素方差分析和x2检验法进行统计学检验.结果 不同教育程度早产妇女孕早期检查率低于足月产妇女(从小学、初中、高中到大学的孕早期检查率早产组分别为82.89%、91.06%、93.96%、93.11%;足月产组分别是86.36%、93.95%、95.65%、96.41%,P=0.008).教育程度高的妇女孕早期检查率高于教育程度低的妇女(早产组RD=-10.22,RR=0.89,CI=0.0131;足月产组RD=-10.05,RR=0.90,CI=0.0104);不同教育程度早产妇女产前检查次数达标率低于足月产妇女(从小学、初中、高中到大学的早产组分别为86.54%、93.17%、92.99%、96.49%;足月产组分别是94.60%、96.65%、96.15%、96.66%,P=0.005).教育程度越高,产前检查次数达标率越高(早产组RD=-9.95,RR=0.90,CI=0.0077;足月产组RD=-2.06,RR=0.98,CI=0.0006);住院分娩率在不同教育程度早产组与足月产组妇女之间存在差异(从小学、初中、高中到大学的早产组分别为98.42%、99.54%、99.61%、100.00%;足月产组分别是99.45%、99.75%、99.83%、99.77%,P=0.005).无论早产组还是足月产组其教育程度较高的妇女住院分娩率也较高(早产组RD=-1.58,CI=0.0013;足月产组RD=-0.32,CI=0.0003).结论 不同教育程度早产妇女在产前保健利用方面存在不公平.同等教育程度比较,足月产妇女的公平性要好于早产妇女.     

农村孕产妇保健现况调查

目的:了解重庆市铜梁县农村孕产妇保健状况,探讨农村孕产妇保健的影响因素。方法:采用分层整群抽样方法,抽取重庆市铜梁县2006年产妇400人进行问卷调查,采用χ2检验法、Logistic逐步回归进行统计分析。结果:农村孕产妇产前检查率为94.5%,孕早期检查率为49.6%,住院分娩率为95.5%,产后访视率63.25%,系统管理率为9.5%,影响农村孕产妇保健的主要因素是年龄、职业、活产生育数、文化程度、经济条件、就医距离和就医时间、母婴保偿制。结论:农村孕产妇孕早期检查时间滞后,产后访视率较低,农村孕期保健服务亟待加强。     

西藏农牧区妇女孕产期保健现状分析

目的 了解西藏自治区农牧区妇女孕产期保健现状.方法 采用横断面调查方法,分层随机抽样,入户访问了1512名3岁以下儿童的母亲.结果 妇女产前检查覆盖率为77.6%,平均产前检查次数为3.89次,5次以上产前检查率为26.3%,住院分娩率为40 4%,83.9%的妇女接受过孕期卫生保健宣传教育,产后访视的比例为66.2%.家庭有无副业收入、是否牧区、个人卫生状况、产前保健宣传教育、动员住院分娩、孕期保健知识等是影响是否进行产前检查的主要因素.结论 该地区妇女孕产期保健状况有显著改善,但目前产前检查次数仍然偏低,住院分娩率偏低,缺乏孕产期保健常识是影响孕产期保健利用的主要因素之一.建议加强健康教育,普及孕期卫生保健知识,促进产前保健和住院分娩.     

新疆生产建设兵团已婚育龄妇女孕产期保健状况调查

目的：了解新疆生产建设兵团1971-2006年间孕产期保健状况。方法：采取分层整群、四阶段、概率比例随机抽样方法,调查员入户面对面问卷调查。结果：共调查有活产已婚育龄妇女6624人,2001年以来,产前检查率、孕早期（妊娠≤12周）检查率、师直≥8次产前检查率、团场≥5次产前检查率、住院分娩率分别达到了86.60％、66.64％、58.70％、65.19％、82.01％,在家分娩率降到14.10％,而产后访视率仅为32.01％。育龄妇女的分娩时期、民族、受教育程度、生育史、家庭年收入、职业与是否参加产前检查有关。结论：近几年孕产期保健状况有明显改善,但产前检查率、孕早期检查率和产后访视率偏低,应特别加强对文化程度低、从事农业、少数民族孕妇的健康教育,普及孕产期卫生保健知识,规范产后访视,提高孕产期保健服务质量和服务利用率。     

深圳泥岗社区妇幼卫生服务现状调查

目的 全面了解深圳市泥岗社区妇幼卫生服务现状。方法：抽取泥岗200名有学龄前儿童的母亲作为研究对象，采用调查表进行询问。结果 早孕检查率占69.0%，孕期检查率占97.6%；住院分娩率占88.7%，产后访视率占50.0%；儿童定期进行体格检查占89.2%。结论 要加强医疗服务队伍建设，提高社区卫生服务质量，提高妇幼卫生保健水平。     

浙江农村孕产妇保健影响因素分析

目的：了解浙江农村孕产妇保健状况，探讨农村孕产妇保健的影响因素。方法：采用多阶段分层系统抽样方法，抽取浙江省11个县市农村1998年1月1日-2003年10月20日有活产的15-49岁已婚育龄妇女共计889人，对其孕产期保健状况分别进行问卷调查，分析采用χ^2检验法。结果：浙江农村孕产妇产前检查率为99．67％，住院分娩率97．83％，剖宫产率31．91％，产后访视率（至少3次）76．32％。孕产妇保健主要影响因素是文化程度、生育活产儿数。结论：浙江省农村孕产妇保健状况、产前检查率、早孕检查率、产前5次检查率、住院分娩率、产后访视率（至少3次）达到全国甲类农村保健服务标准。     

佛山市某区1岁以下流动儿童保健服务利用与其母亲孕产期保健服务的相关性研究

目的 探讨1岁以下流动儿童保健服务利用与其母亲孕产期保健服务的相关性,为进一步提高流动儿童保健服务利用提出建议。方法 采用横断面调查,选取佛山市某区1岁以下流动儿童母亲579名为对象,对其进行面对面的问卷调查,利用二分类Logistic分析儿童系统管理与其母亲孕产期保健服务利用的相关性。结果 流动儿童保健服务利用现状为:儿童体检率89.1%,儿童系统管理率49.2%;流动儿童母亲孕产期保健服务利用现状为:产前检查率96.0%,孕早期检查率87.5%,≥5次产前检查率61.5%,住院分娩率99.7%,产后访视率37.3%,孕产妇系统管理率22.2%;多因素分析结果显示母亲产后访视、孕产期系统管理分别与儿童系统管理呈正相关(OR=2.017,95%CI=1.339~3.038;OR=1.941,95%CI=1.208~3.119)。结论 流动人口妇幼保健服务全程利用水平相对较低;母亲产后访视和孕产期系统管理是儿童系统管理的促进因素,提示母亲孕产期保健服务利用的改善可能有助于进一步提高儿童保健服务的利用。     

宁夏彭阳县农村育龄妇女健康保健及孕产妇分娩情况调查

目的了解宁夏彭阳县农村育龄妇女健康保健及孕产妇分娩情况。方法采取分层随机抽样的方法抽取彭阳县33个村1 275名育龄妇女进行现场问卷调查。调查内容包括一般情况、育龄妇女健康体检情况及孕产妇分娩情况。结果调查的1 275名妇女中,接受过妇科检查的育龄妇女占28.20%(359/1 275)。30~39岁组育龄妇女的妇科检查率高于15~29岁组,汉族育龄妇女的检查率高于回族,不同文化程度育龄妇女妇科检查率不同;有分娩史的171名育龄妇女中,住院分娩率为88.30%。在家中分娩占11.70%,主要原因为来不及(70.00%)和没有必要去医院(20.00%),且家中分娩主要请家人接生(65.00%)。93.57%孕妇做过产前检查,41.52%产妇有产后访视。结论对彭阳县育龄妇女加强生殖健康知识教育,鼓励主动参加妇科检查,对孕产妇加强孕产期保健知识教育,提高产前检查率和住院分娩率,加大产后访视服务工作力度,规范产后访视工作。     

A New Method to Examine Very Low Birth Weight Fetal and Hebdomadal Mortality in a Regionalized System of Perinatal Care

Objective: Aggressive maternal transport of very low birth weight (VLBW) live births from community hospitals to regional perinatal centers may artificially increase community fetal death rates. By allocating maternal transports according to the location of antepartum and intrapartum care and separately computing antepartum and intrapartum fetal mortality rates, a more appropriate measure of hospital-based mortality may be determined. Method: Delivery charts were reviewed for 568 VLBW deliveries (including 97 fetal deaths and 77 hebdomadal deaths) occurring between 1990 and 1992 in a geographically defined perinatal region. Maternal transports were analyzed with community hospitals for antepartum mortality rates and with the regional center for intrapartum mortality rates. Results: Using traditional methods, the fetal mortality rates for community hospitals and the regional center were antepartum 385.1 vs. 45.2, respectively, and intrapartum 120.9 vs. 24.9, respectively. When regional center live births (maternal transports) are placed with community hospitals for analysis of antepartum mortality, the new antepartum mortality rates were 185.7 vs. 72.8, respectively. The hebdomadal mortality rate for community hospitals was 250.0 as compared to 145.8 for the regional center. Conclusion: Maternal transports to a regional center represent successful antepartum management by community care providers. Even though they delivered in the regional center, they should be analyzed with community hospitals for antepartum fetal mortality comparisons. Therefore, antepartum and intrapartum fetal mortality should be examined separately in a functioning regionalized perinatal care program where the location of patient care differs from location of delivery.     

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth.     

Avoidable perinatal deaths in Belo Horizonte,Minas Gerais,Brazil, 1999

The perinatal mortality rate is still high in Belo Horizonte. This study investigated all 826 perinatal deaths taking place in 1999, focusing on the possibility of their prevention, using the Wigglesworth classification. The perinatal mortality rate was 20.2 per one thousand births, and the risk of perinatal death was 20 times higher in children with low birthweight. Some 24.6% of the children weighed more than 2,500g, and the main cause of death in this group was asphyxia during labor. The antepartum cause of death contributed to 30% of all deaths, and 25% of these children weighed more than 2,500g. Some deaths occurred out of hospital, and in some cases the mother arrived at hospital in end-stage labor. About 40% of all perinatal deaths or 60% of all early neonatal deaths could have been prevented, suggesting flaws in prenatal, intrapartum, and neonatal care at both the clinical and health-care organizational levels. To intervene in this situation, progress is needed in improving quality of care and ensuring accountability in the specific health services and the health care system as a whole.     

Antenatal and perinatal care in Jamaica: do they reduce perinatal death rates?

Summary. Information concerning 9919 singleton pregnancies delivered in Jamaica in the 2-month period of September and October 1986 and surviving the early neonatal period were compared with 1847 singleton perinatal deaths occurring in the 12-month period from 1 September 1986 to 31 August 1987, classified according to the Wigglesworth schema.
Logistic regression was used to assess features of antenatal and intrapartum care that were associated with the different groups of perinatal death after taking account of environmental, maternal and medical factors.
In Jamaica, 67% of all mothers took iron during pregnancy. These mothers appeared to have a lower risk of perinatal death. This does not appear to be an artefact related to the gestation at which the mother delivers, and was particularly associated with antepartum fetal deaths.
Commencement of antenatal care in the first trimester appeared to reduce the risk of all perinatal deaths, and for intrapartum asphyxia in particular. It is speculated that the mechanism may involve early detection and treatment of anaemia and syphilis.
Quality of perinatal care available in the area of residence, as measured by the presence of consultant obstetricians and a paediatric consultant unit, is shown to be significantly related to a reduction in deaths from intrapartum asphyxia, but it appeared not to be related to antepartum fetal deaths.     

The Impact of National Health Insurance on the Utilization of Health Care Services by Pregnant Women: The Case in Taiwan

Objectives: Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Methods: Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. Results: The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. Conclusions: The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.     

A Survey of Obstetric Healthcare Utilization in the Rural Western Indian Himalayas

Objectives To determine the socio-economic factors affecting access to antepartum, intrapartum, and postpartum healthcare in the rural Western Indian Himalayas over the past 20 years. Methods Face-to-face surveys were conducted with 197 women in Chamoli District, Uttarakhand from October 2011 to May 2012. Participants who gave birth within the past 20 years were included in the final analysis (n = 158). Stratified odds ratios and analysis of variance were calculated. Results Among women who delivered in the prior 7 years, there was a nine-fold increase (95 % CI 4–20.8) in institutionalized births compared to women who delivered 8–20 years before the study. Among women who delivered 7 years prior to the study, low income increased the risk of home delivery (OR 3.07, 95 % CI 1.15–8.54). Low caste (OR 2.79, 95 % CI 1.04–7.72) and low level of education (OR 3.93 95 % CI 1.41–11.81) decreased the use of antepartum medications (vitamins and vaccines). Remote location among all participants was a risk factor for not seeking care for obstetric morbidities (OR 0.44 95 % CI 0.2–0.95). Conclusions The incidence of institutionalized delivery has increased over the past decade in rural Uttarakhand. Income, caste, education, and remote location correlated with poor access to antepartum and intrapartum healthcare. These correlations have increased in statistical significance over the past 20 years, except for location. This indicates that the Western Himalayas face similar challenges to obstetric service utilization as the north Indian plains and that several of these inequalities in healthcare access have become more pronounced in recent years.     

非计划医院外分娩产妇产后出血的临床分析

目的:探讨非计划医院外分娩产妇产后出血的产科特征及防治方法。方法:对1993年1月~2005年12月我院收治的116例院外分娩产后出血病例进行回顾性分析。结果:13年间非计划院外分娩产妇产后出血共116例,占同期产后出血21.93%,平均出血量863.60ml,89.66%发生在产后2h内。院外分娩产妇趋向于年龄大、产次多、教育程度低、社会经济地位低下和缺乏产前检查。子宫收缩乏力(49.14%)、胎盘滞留(40.52%)、软产道损伤(10.34%)是产后出血的主要原因。仅2例行全子宫或次全子宫切除术,无1例死亡。结论:非计划医院外分娩是产后出血的重要危险因素,应切实加强计划生育和围产期保健工作,坚决取缔非法诊所和非法接生,提高住院分娩率以降低产后出血的发生。     

不同户籍产妇孕产期保健状况调查

目的:了解北京市不同户籍产妇孕产期保健状况,为提高孕产期保健水平提供依据。方法:于2003年8～12月对北京市9所助产单位分娩的825例产妇进行问卷调查,其中本市户口产妇480例,外地户口产妇345例。结果:①本市产妇孕期平均产检次数(9.2±3.6)次,外地产妇(7.8±3.5)次(t=5.42,P=0.000)。本市和外地产妇进行产前检查与产妇的职业、文化水平、家庭经济条件和生育次数有关。②本市和外地产妇在产前检查过程中去医院感觉方便者占67.9%。③本市产妇孕妇学校的听课率为50.2%,外地产妇为34.8%(χ2=19.41,P=0.000)。④本市产妇剖宫产率59.4%,外地产妇为42.9%(χ2=21.85,P=0.000)。⑤本市和外地产妇愿意母乳喂养者占97.5%,产后2～7天母乳喂养者为86.8%。⑥本市产妇产后避孕方式知晓率为72.7%,外地产妇为55.4%(χ2=26.71,P=0.000)。结论:①流动人口妇女孕产期保健状况应予关注。②针对本市和外地产妇产前检查不便利、孕妇学校听过课比例较低、剖宫产率较高、产后避孕知识知晓率不高的共同特点,应充分利用孕妇学校加强产时分娩方式及产后避孕方式选择的宣教,提倡以孕产妇为中心的产科服务模式。     

Current trends in perinatal mortality statistics at the New Jersey Obstetric Center

The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.