社区妊娠风险预警筛查、评估和妊娠结局分析

目的:了解社区卫生服务中心妊娠风险预警筛查、评估和妊娠结局情况,探索对重点孕妇有效的社区干预措施,不断完善"妊娠风险预警评估"工作。方法:对2010年7月～2011年6月在上海市卢湾区4个社区卫生服务中心回收的1 726本上海市孕产妇保健手册的妊娠风险预警筛查情况、重点孕妇确诊情况和妊娠结局进行分析。结果:重点孕妇发生率21.21%,外地户籍的重点孕妇发生率明显高于上海市户籍;筛查阳性的前3位是"基本情况","家族史","异常妊娠分娩史、妇产科疾病及手术史",固定因素中常见的包括瘢痕子宫、年龄≥35岁、双胎、体重指数(BMI)24、异常妊娠分娩史、子宫肌瘤或卵巢囊肿≥6 cm,占筛查阳性数的51.09%,确诊率为62.41%;重点孕妇的早产和低体重发生率及剖宫产率明显高于正常孕妇。结论:有效的干预措施包括立足社区重视筛查,提升社区在重点孕妇管理工作中的服务功能;依托网络规范转诊,充分发挥妇幼保健所在重点孕妇管理工作中的枢纽作用;有的放矢,努力降低重点孕妇的发生率;加强对重点人群的宣教,降低重点孕妇不良结局的发生;管理模式不断完善,提高重点孕妇管理的整体性、连续性及有效性。

Screening and evaluation of risk early warning of pregnancy in community and analysis of pregnancy outcome

Objective:To understand screening and evaluation of risk early warning of pregnancy in community and pregnancy outcome in community health service center,explore effective intervention measures targeting to key pregnant women in community,and perfect " evaluation of risk early warning of pregnancy".Methods:The screening situations of risk early warning of pregnancy,definite diagnosis of key pregnant women,and pregnancy outcomes of 1 726 copies of Shanghai maternal health care manual retrieved from four community health service centers in Luwan district of Shanghai city from July 2010 to June 2011 were analyzed.Results:The incidence of key pregnant women was 21.21%,and the incidence of key pregnant women in migrant population was statistically significantly higher than that in resident population;the top three positive factors during screening were " basic situations"," family history",and " the history of abnormal pregnancy and delivery,the history of gynecological and obstetrical diseases,and the history of surgery";the common fixed factors included scarred uterus,≥35 years old,twin pregnancy,body mass index(BMI)>24,the history of abnormal pregnancy and delivery,and the diameters of hysteromyoma or ovarian cyst≥6 cm,which accounted for 51.09% of the total positive number,the confirmed diagnostic rate was 62.41%.The incidences of premature delivery and low body weight,and the cesarean section rate in the key pregnant women were statistically significantly higher than those in normal pregnant women.Conclusion:The effective intervention measures include paying attention to screening and improving the service function of community on management of key pregnant women based on community,playing the pivotal role of maternal and child health institutions in management of key pregnant women based on formal network transfer treatment,making great efforts to reduce the incidence of key pregnant women correspondingly,enhancing propaganda and education among key population,reducing the occurrence of adverse outcome in key pregnant women,perfecting management mode constantly,and improving the integrity,continuity,and effectiveness of maternal management.