北京市2001-2010年孕产妇产后出血死亡相关因素分析

目的了解北京市2001-2010年孕产妇产后出血死亡情况,并探讨其影响因素。方法回顾性分析北京市2001年1月-2010年12月40例孕产妇产后出血死亡病例、评审结果及WHO十二格表资料。结果①2001-2010年北京市孕产妇产后出血死亡率由2003年的10.5/10万下降至2010年的0.6/10万,其中外来人口产后出血死亡率由2003年的22.7/10万下降至2010年的1.2/10万。②63.6%(21/33)的外来人口孕产妇在私人诊所或家中分娩;其中54.5%(18/33)无产前检查;死亡距分娩时间主要在产后12h内(69.7%,23/33);转诊延误(81.8%,27/33)明显。③7例北京户籍孕产妇中,6例在二、三级医院分娩;剖宫产、阴道分娩者各3例;5例产前检查6次以上;2例死亡距分娩时间在产后12h内,3例在产后1～42d内。发生多器官功能衰竭(MODS)5例。④产后出血原因中,子宫收缩乏力及软产道损伤为主要因素(75.0%,30/40);产后出血发生时间集中在产后2h内,占97.5%(37/40),并集中在夜班、周末及节假日(80.0%,32/40);市级评审可避免死亡和创造条件可避免死亡者占85.0%(34/40)。⑤北京户籍孕产妇死亡与医疗保健知识技能(6例)、态度(2例)、资源(3例)及管理(6例)因素有关;外来人口孕产妇死亡主要与个人家庭知识技能(42.4%,14/33)、态度(66.7%,22/33)、资源(36.4%,12/33)、医疗保健知识技能(45.5%,15/33)及社会管理(54.5%,18/33)有关。结论产后出血的主要原因是子宫收缩乏力和软产道损伤。其发生时间集中在产后2h内,死亡时间集中在产后12h内。北京户籍孕产妇产后出血死亡主要与医疗保健知识技能、态度、资源及管理有关;外来人口孕产妇产后出血死亡主要与个人家庭知识技能、态度、资源及社会管理有关。

The analysis of the maternal mortality caused by postpartum hemorrhage in Beijing during 2001-2010

Objective To investigate the situation of maternal mortality caused by postpartum hemorrhage in Beijing during 2001—2010 and analyze the causes of death. Methods Every maternal death caused by postpartum hemorrhage adopted from 2001 to 2010 and relevant information was collected and analyzed retrospectively. Results ①The maternal mortality caused by postpartum hemorrhage in Beijing during 2001—2010 declined overall, especially in the migrating population. ② The migrating peopler features included labor at home, less prenatal checks, death occurred within 12 hours after labor and referral delay. ③The native peopler features included labor at general hospital, the similar proportion of natural labor and cesarean, regular prenatal checks, death occurred during 1～ 42 days after labor. ④The maternal death concentrated in night shift, holiday and weekend. The uterine atony and birth canal injury were the main reasons in postpartum hemorrhage. The assessment on the death cases by experts were mainly avoidable and conditionally avoidable. ⑤ According to the WHO twelve - grade classification standard on maternal death, we found that the main reasons of maternal death of Beijing residents’ death were related to the skills （6 cases） and attitude （2 cases） of medical staffs and healthcare＇ resources （3 cases） and management （6 cases）.The main reasons of migrating population＇ maternal death were individual poor knowledge （42. 4%）, indifferent attitude （66. 7%）, the familyt resources （36.4%） and social management （45.5%）. Conclusion To decrease the maternal mortality caused by postpartum hemorrhage, clinical knowledge and skills training in doctors and nurses should be strengthened. Health education and economic support are very important for the migrating population. Illegal clinics should be banned and home births should be forbidden.