我国农村孕产妇死亡的流行病学分析

目的 了解1996～2001年我国农村孕产妇死亡率、趋势、主要死因和变化特征。方法在全国31省、自治区、直辖市孕产妇死亡监测网内采用以人群为基础的流行病学调查方法。结果1996～2001年农村孕产妇死亡率由86．4／10万下降到61．9／10万，下降幅度为28．4％；农村孕产妇主要死亡原因为产科出血、妊娠高血压综合征和羊水栓塞等，产科出血死亡率由1996年的48．3／10万下降到2001年的33．0／10万，农村死亡孕产妇主要在家分娩，2001年在家分娩比例为44．6％，在家死亡的比例为30．1％。结论 1996～2001年农村孕产妇死亡率呈下降趋势，产科出血死亡率也呈下降趋势，降低农村孕产妇死亡率的主要措施是减少产科出血，提高住院分娩率。     

四川贫困地区农村孕产妇保健服务利用现状分析

目的 了解四川省贫困地区农村孕产妇保健服务利用的现状,并分析其影响因素.方法 采用分层整群抽样的方法,采用自行设计的"孕产妇卫生保健服务调查表"对1998以来分娩过或目前怀孕的妇女进行面对面访谈.结果 共调查了462名孕产妇,其中接受过产前保健服务的孕产妇人数最多,有387人(83.77%);接受了产后访视的人数最少,仅有144人(31.17%).不同年龄段、不同文化程度孕产妇,其孕前保健利用率、产前保健利用率和住院分娩率差异有统计学意义(P<0.05),年收入低(<1000元)的孕产妇在利用保健服务方面的情况明显差于年收入较高(>5000)元的孕产妇(P<0.05),享受合作医疗保险和贫困医疗保险的孕产妇在孕前保健、产前检查、住院分娩和接受产后访视方面的情况都明显好于完全是自费的孕产妇(P<0.05.结论 四川贫困地区农村孕产妇保健利用状况仍不容乐观,这可能与该地区经济水平较低,育龄妇女文化程度不高,医疗保险普及率较低有关.     

重庆市1999～2008年孕产妇死亡流行病学特征分析

目的 分析重庆市1999～2008年孕产妇死亡率、死因构成、影响因素及死亡孕产妇接受卫生保健情况,探讨相应的干预措施.方法 利用孕产妇死亡报告卡及死亡评审结果进行统计分析.结果孕产妇死亡率由1999年的79.01/10万下降到2008年的35.20/10万, 首位死因一直是产科出血.死亡孕产妇接受产前保健服务差,计划外生育对孕产妇死亡率有重要影响.结论重庆市孕产妇死亡率有自身明显的特点.建议从加强产前保健服务、加强助产技术和计划外生育管理等方面着手来降低孕产妇死亡率.     

116例孕产妇死亡分析

本文对1994～1996年间我市七县五区的116例孕产妇死亡进行回顾性分析。3年间活产数153896次，孕产妇死亡116例，死亡率75．38／10万。孕产妇死亡原因中，直接产科死因占88．79％，主要死因依次为产科出血、妊高征、羊水栓塞、心脏病、产褥感染。产科出血占全部死因的56．70％。孕产妇接受保健措施不够，32.76％的孕妇死前未接受过一次产前检查，50．86％的孕产妇未能住院分娩，半数以上的孕妇死于家中和转送途中。     

1996～2002年广西横县孕产妇死亡监测情况分析

目的　掌握广西横县 1996～ 2 0 0 2年孕产妇死亡发生情况及死亡相关因素 ,为政府提供决策依据。方法　按照全国统一的孕产妇死亡监测方法 ,对 1996～ 2 0 0 2年横县 2 2个乡镇孕产妇死亡监测的数据和资料进行回顾分析。结果　 7年来横县孕产妇死亡 5 8例 ,平均死亡率是 72 6 1/ 10万 ,2 0 0 2年较 1996年上升 90 2 5 % ;孕产妇死亡前 4位原因依次是 :产科出血 ;妊娠合并心脏病 ;妊高征 ;羊水栓塞构成比为 4 6 5 5 %、12 0 7%、10 34%、6 9%。死亡病例中居住山区的占 5 1 72 % ,计划外怀孕占 4 1 38% ,孕期属高危妊娠的占 5 0 0 0 % ,孕期没有参加围产保健的占 2 4 14 % ,家庭分娩的占 32 76 %。结论　我县孕产妇死亡率高于全国水平 ,且有抬升趋势 ,产科出血、妊娠合并心脏病是主要死因之一。应采取相应干预措施 ,提倡住院分娩 ,提高产科质量 ,加强适宜技术的培训 ,做好高危孕产妇监护管理 ,是降低孕产妇死亡率的关键。     

三亚市2000～2008年农村地区孕产妇死亡监测情况分析

目的了解农村地区孕产妇死亡原因。方法对三亚市农村地区2000～2008年孕产妇死亡监测情况进行回顾性分析。结果2000～2008年度三亚市农村活产数为43618人,孕产妇死亡23例,平均死亡率为52.73/10万,各年度间孕产妇死亡差异有统计学意义(P0.05)。农村孕产妇死亡受当地经济文化水平影响较明显。结论应采取包括提高孕产期保健覆盖率、住院分娩救率、加大投入、健康教育等综合性措施,切实降低农村孕产妇死亡率。     

30例孕产妇死亡分析

目的通过对2000年～2007年死亡孕产妇资料的分析,探讨孕产妇死亡率以及导致孕产妇死亡的原因,了解当前孕产妇管理的现状。方法对30例死亡孕产妇资料进行回顾性分析。结果8年孕产妇死亡30例,死亡率43.10/10万;主要死亡原因为羊水栓塞33.33%,产后出血33.33%,妊娠期高血压疾病占10%等。在乡镇卫生院以下死亡19例,占63.33%。无产前检查13例,占43.33%。结论加强围生期保健,普及围生期保健知识,提高产科从业人员的综合素质和综合应急能力,是降低孕产妇死亡率的关键。     

70例孕产妇死亡情况的调查分析

本文通过对我县1989～1992年农村地区70列孕产妇死亡状况的回顾性调查,掌握了本县农村孕妇死亡率,其中以居住山区者显著偏高。孕产妇死亡各种因素构成顺位中,主要以产后死亡、计划外生育及直接产科原因分居首位。通过对孕产妇死亡前的保健措施情况调查分析,提出了降低孕产妇死亡的一些相应措施。     

产科出血死亡34例原因分析

目的：分析产科出血死亡原因,提出干预措施,提高固产期保健质量,降低孕产妇死亡率。方法：长春地区10个县（市）、区,按国家统一要求,填报孕产妇死亡报告卡,逐级上报长春市妇幼保健所。结果：2002～2006年长春地区死亡孕产妇共96例。其中因产科出血死亡34例,占死亡的35．41％。而在产科出血死亡中,因产后宫缩乏力死亡的孕产妇22例;因家庭分娩死亡孕产妇2例;因转院途中死亡孕产妇4例。结论：加强农村、乡级保健网建设,取缔家庭分娩,提高农村、乡级产科质量,加强妇科理论学习,认症、识症,是减少产科出血的发生,更是降低孕产妇死亡率的重要措施。     

原州区2000～2009年孕产妇死亡分析

目的:对原州区2000～2009年连续10年孕产妇死亡监测进行分析,为研究本区孕产妇死因变化规律,实施干预措施,有效降低孕产妇死亡率提供科学依据.方法:采用流行病学研究方法,对原州区2000～2009年孕产妇死亡情况连续监测.结果:孕产妇死亡率由2000年的111.01/10万下降到2009年的15.95/10万.结论:孕产妇死亡率下降的主要原因是通过实施"降消"项目和瑞典妇幼卫生项目,实行孕产妇有偿保健服务和住院分娩救助,加强孕产妇系统管理,提高住院分娩率,完善乡镇卫生院产院建设和妇幼保健机构自身建设.     

Maternal health services and maternal mortality in Papua New Guinea

Surveys of maternal mortality rates in rural areas of Papua New Guinea over the past thirty years report 2-18 deaths per 1000 live births. The national maternal mortality register commenced in 1970 and reports rates of 2-7/1000 deaths for urban areas and 7-20/1000 deaths for rural areas. However, less than a quarter of maternal deaths are believed to be reported to the register: most of the unreported deaths are unsupervised confinements. Nevertheless obstetrical causes now account for 20% of total admissions to hospital and health centres in Papua New Guinea, and are the commonest causes of admission. The great majority of obstetrical admissions come from urban and periurban areas. Most rural women continue to confine at home where only a small fraction of maternal deaths are reported. It is as yet unclear whether modern health services have made any impact on rural maternal mortality rates. A plea is made for more complete reporting of maternal deaths to the national register of both supervised and unsupervised confinements.     

1996～2002年宁夏孕产妇死亡监测分析

目的：通过对宁夏孕产妇死亡资料分析，阐述宁夏山区、川区孕产妇死亡的基本特点与发展趋势．为进一步降低孕产妇死亡率提供科学依据。方法：对1996～2002年宁夏9个监测县孕产妇死亡情况进行统计分析：结果：7年间宁夏孕产妇死亡率下降幅度很大，从1996年130．97／10万下降到2002年72．01／10万，平均每年下降7．50％.山区下降更加明显；产科出血居孕产妇死因首位。山区产科出血占60％，孕产妇死亡76．67％发生在家中或路途。川区孕产妇死因主要为羊水栓塞、妊高征、产科出血，孕产妇死亡有71．11％发生在医院。结论：进一步降低孕产妇死亡率的重点仍在山区．应加强山区孕产妇系统管理，提高住院分娩率，同时重视家中分娩前后产科出血的预防和救治。     

Maternal mortality in a district hospital in West Bengal

To ascertain the causes of high maternal mortality in West Bengal, the author examined maternal mortality between 1964-68. It was intended that measures to improve the situation in rural areas could be suggested. Women in labor often arrive at the hospital very late and few antenatal care facilities are available in rural areas. High risk cases often are delivered at home, a situation which often results in fetal complications. Maternal deaths have declined, but not dramatically. Of the 24,265 deliveries at the Burdwan district hospital, there were 333 maternal deaths for an incidence of 13.7/1000, along with another 42 cases where death was due to pregnancy-associated causes. In contrast, the maternal mortality rate in a district hospital in Calcutta was 4/1000 in 1968. Eclampsia accounted for 42.34% (141) of maternal deaths making it the major cause of death. In Calcutta this cause of death is receding gradually but in the districts it still accounts for a heavy loss of life (an incidence of 1 in 38). Adequate antenatal care would reduce this high mortality. 2 factors which have contributed to the high mortality are the hours lost in transporting a patient from a rural area and inadequate hospital staff. Postpartum hemorrhage and/or retained placenta was responsible for 39 deaths and none of the cases admitted from outside had received antenatal care. A shortage of blood was also a contributory factor. Severe anemia was responsible for 34 deaths and abortions resulted in another 29 deaths (16 because of severe sepsis; 13 due to hemorrhage or shock). An emergency service would help reduce the number of deaths but at present such a service does not even exist in the urban areas. Ruptured uterus resulted in 29 deaths and obstructed labor in 27 deaths. Placenta previa brought about 14 deaths and the remaining 20 deaths were due to such causes as accidental hemorrhage (10), hydatidiform mole (4), puerperal sepsis (3), ectopic pregnancy (2), and uterine inversion (1). Timely admission would have helped most of these cases. In summation, the preventive measures which would help to lower maternal mortality are: 1) mass education about the need for antenatal care, 2) provision of good obstetrical service, 3) provision of quick transport, 4) adequate staffing of hospitals, 5) refresher courses for medical personnel, and 6) 24 hour blood transfusion service.     

Mortality rates and the utilization of health services during terminal illness in the Asaro Valley, Eastern Highlands Province, Papua New Guinea

Between 1980 and 1989 we carried out fortnightly demographic surveillance in a random sample of people living in Goroka town, periurban areas and rural areas in the Lowa and Asaro Census Divisions, all within 1 1/2 hours' drive of the town in the Asaro Valley, Eastern Highlands Province. Cause of death was determined by verbal autopsy supplemented by any available health service information. Crude death and birth rates were 10 and 32 per 1000 person-years, respectively, in 59,906 person-years at risk. The standardized mortality ratio increased with increasing distance from town. Life expectancy at birth was 57 years for males and 55 years for females. The stillbirth rate was 19 per 1000 births, neonatal and infant mortality 21 and 60 per 1000 livebirths, respectively, and 1-4-year mortality 9 per 1000 person-years. Maternal mortality was 3 per 1000 births. Neonatal and infant mortality were respectively 7 and 3 times as high in Asaro Census Division as in Goroka town. Acute lower respiratory tract infections accounted for 22% of all deaths, chronic obstructive lung disease 10%, trauma 8% and gastroenteritis/dysentery 7%. 76% of deaths occurred at home and 44% of people who died had no treatment during their terminal illness. Health services were used most frequently by urban dwellers and by the young. To reduce mortality, a political commitment to provide functioning health services in rural areas is needed; regular supervision of health staff, ensuring the safety of staff and their families, availability of antibiotics as near people's homes as possible and regular mobile maternal and child health clinics are essential. Health education should include recognition of signs of severe disease and the importance of seeking treatment early. In view of high maternal and neonatal mortality, user fees should be waived for pregnant women.     

Maternal mortality in Papua New Guinea 1976-1983

In April 1970 a Maternal Mortality Register (MMR) was started in Papua New Guinea to record in more detail deaths occurring both at home and in health care facilities. This paper reports 628 maternal deaths for which death certificates were registered and 385 deaths reported to the Maternal Mortality Register (MMR) for the January 1, 1976-December 31, 1983 period. A total of 895 maternal deaths were reported between January 1, 1976 and December 31, 1983. The annual average was 111, but the average number of deaths reported to the MMR was only 48. This represents a marked decrease in the reporting rate from previous reports. The number of deaths reaching the Death Registry (DR) was fairly consistent for the period, and the percentage of hospital and health center deaths registered was high (78-96%). Yet, the number of deaths being notified to the MMR was erratic and considerably less complete (18-55%). Notably, the percentage of deaths notified to both the MMR and the DR has been very low throughout the period (2-22%). It seems that many health workers feel that notification to 1 registry is sufficient. With the marked decline in reporting maternal deaths to the MMR it is more difficult than previously to calculate the maternal mortality rate for Papua New Guinea. A table presents the maternal mortality figures previously reported from the registry. According to Bell (1983) the rate was 1.6/1000 births in urban areas, 10/1000 in rural areas, and 9/1000 overall. The authors of this report think that the rate varies from approximately 2/1000 for urban areas, to 20/1000 in areas without accessible health services. It is probably about 8/1000 overall. According to this estimate, 1/10 of the maternal deaths were reported for the period under review. A table shows the causes of 895 maternal deaths, and another table groups the deaths according to whether they were reported to the MMR or the DR. For 22 of the village deaths and 6 of the institutional deaths it was not possible to determine the cause of death from the information provided. Relatively few deaths from trophoblastic disease, ectopic pregnancy, and abortion were notified to the MMR because of their less obvious "maternal" nature. The causes of death were as follows: puerperal sepsis -- 195 deaths recorded by the DR and 76 by the MMR; postpartum hemorrhage -- 130 recorded by the DR and 102 by the MMR; associated medical and surgical complications -- 140 deaths, which accounted for 26% of the deaths notified to the MMR and only 10% of locatable deaths in the DR; prolonged or obstructed labor (45 deaths) and ruptured uterus (38 deaths), with the MMR showing that primigravidas accounted for 45% of the deaths from prolonged and obstructed labor and grandmultiparas accounted for 60% of the deaths from ruptured uterus; abortion, 38 deaths; antepartum hemorrhage, 36 deaths; eclampsia, 30 deaths; trophoblastic disease, 25 deaths; pulmonary embolus, 25 deaths; actopic pregnancy, 20 deaths; 14 operative and anasthetic deaths; 10 miscellaneous causes of death; and 39 deaths associated with caesarean section.     

Status of Equities in Prenatal Care Utilization and Changing Patterns among Women in China

Equity in health care means that available health resources are fairly distributed so that everyone has the equal opportunity to get benefits. So to decease the inequalities in health and health care utilization and to fulfill the basic requirements is ne…     

1996-2015年长治市婴儿死亡率变化趋势及相关因素分析

目的：：通过对长治市近20年婴儿死亡率变化趋势及相关因素的分析,提出干预措施,为政府部门制定儿童生存、保护和发展的方针和政策提供科学依据。方法：对长治市1996—2015年婴儿死亡监测资料进行整理、统计,分析婴儿死亡率变化趋势及死亡分布特征。结果：长治市婴儿死亡率从1996年的30.98‰至2015年的4.96‰,20年时间里呈逐年下降趋势,下降幅度为30.99%,年均下降率为9.19%。农村下降幅度快于城市,城乡差别缩小。先天畸形、早产/低体重、新生儿窒息、肺炎和先天性心脏病是长治市婴儿的主要死亡原因。结论：做好孕期保健,提高产科接生技术,减少早产、窒息、先天缺陷儿的出生。加强新生儿科建设,鼓励儿科医生进产房,提高新生儿救治水平以及婴儿健康管理工作,是降低婴儿死亡率的关键。     

Hazards of childbirth in West Malaysia

Malaysia's maternal mortality rate has been showing a steady decline and in 1966 was 1.7/1000 in contrast to the 6.7/1000 rate in 1948. Yet, considerable variations exist within the country, from as low as 0.31/1000 in the large towns to as high as 5.58/1000 in rural areas. The 554 maternal deaths in 1966 show a marked disparity in racial distribution. Malays who form 50.2% of the total population form 85.5% of total deaths. The possible reasons for this, apart from poverty and malnutrition, are ignorance, fear and prejudice in availing themselves of public health services and reliance on bomohs and handiwomen and fatalism. The other ethnic groups, the Chinese and Indians, make full use of whatever health service is available in their locality. The main obstetric causes for maternal deaths were hemorrhages, neglected labors, and toxemia. Infection was responsible for only 7.5% of the deaths. Among associated diseases, anemia was the predominant cause. Analysis of social factors reveals a high percentage of avoidable factors: 24.2% due to patient errors and 27% due to lack of or inexpert care during antenatal care, and 19% inadequate care in the hospital. In view of the high maternal mortality and fetal loss prevalent particularly in problem districts of Malay, a study of maternal and child health services in the country was undertaken. As a result of this investigation, priority has been given to the idea of bringing the health services to the rural population. In 1968 7.1% of the national budget is being spent on public health services. It is envisaged that for every 50,000 of rural population a Health Unit, consisting of a main Health Center with 4 subcenters and 20 resident midwife cum clinics at the periphery, should be built to serve about 2000 of the population. Thus far 39 main centers, 45 subcenters, and 751 midwife cum clinics have been built and staffed, thus providing obstetric and health services for over 2,000,000 rural population. Other measures that have been taken are outlined. In addition the government has initiated a general rural reconstruction and development projects in an effort to improve the country's social and economic conditions. Particular focus has been on the rural areas.     

2007～2008年南宁市妇幼卫生统计年报主要指标分析

目的通过分析南宁市妇幼卫生工作现状,为今后制定干预措施提供依据。方法对20072008年南宁市妇幼卫生统计年报中的主要指标进行统计分析研究。结果与2007年相比,2008年南宁市孕产妇死亡率有所上升;婴儿死亡率和5岁以下儿童死亡率有所下降。南宁市孕产妇死亡率、婴儿死亡率和5岁以下儿童死亡率存在明显城乡差异。结论南宁市孕产妇保健和儿童保健管理工作有待进一步加强。孕产妇保健和儿童保健的重点应放在农村和城市流动人口,应联合有关部门,加强对城市非户籍常住人口中孕产妇的追踪管理,提高产前检查率和住院分娩率;加大对农村孕产妇健康教育宣传和干预。要重视儿童急性呼吸系统疾病的防治,要积极开展儿童伤害监测,应加强安全教育和积极防范儿童意外