1995-2010年北京市孕产妇死亡情况

目的 分析北京市孕产妇死亡时间变化趋势及孕产妇死亡原因、分娩地点等因素对孕产妇死亡时间的影响。方法 通过北京市三级妇幼保健网络收集报表及孕产妇死亡病例资料（包括孕产妇原始个案调查资料）。每季度组织北京市级专家对孕产妇死亡病例进行评审,明确疾病诊断和死亡原因。将北京市1995-2010年全部372例孕产妇死亡病例资料录入,对死亡时间、死亡原因及相关因素进行x2检验。结果 北京市孕产妇死亡率呈逐年下降趋势,从1995-2000年平均死亡率27.9/10万,下降到2006-2010年的14.8/10万(120/812 457),降幅46.9％。1995-2010年产后出血、羊水栓塞及妊娠期高血压疾病导致的24h内孕产妇死亡106例,占133例产后24h内死亡总数的79.7％。随着产后出血、羊水栓塞及妊娠期高血压疾病死因构成比由1995-2000年的47.8％(64/134)下降到2006-2010年的37.5％(45/120),产后24h内死亡比例也由40.2％(54/134)下降到28.3％ (34/120),死亡时间的变化与直接产科死亡原因的下降趋势一致(x2=59.109,P＜0.05)。2006-2010年间接产科因素死亡如妊娠合并心脏病、脑血管疾病、肺栓塞死亡构成呈上升态势,其53.2％ (33/62)的死亡发生在产前或产后120 h以后。市级医院分娩产妇24h内死亡占其死亡总数的29.0％(29/100),而家中或私人诊所分娩52例,其中43例(82.6％)为产后24h内死亡,分娩地点选择与产后死亡时间差异有统计学意义(x2 =24.500,P＜0.05)。结论 北京市孕产妇死亡时间已由产后24h逐渐转变为产前或产后更长时间,孕产妇死因构成以及服务提供如住院分娩是影响孕产妇死亡时间的重要因素。

Epidemiological analysis of maternal death in Beijing from 1995 to 2010

Objective To analysis the trend of matemal death time and explore the impact of the variety of death causes and birth place to maternal death time. Methods According to the data provided by Beijing Maternal and Children Health Hospital, the 372 death cases of pregnant and lying-in women from 1995 to 2010 ,a retrospective study was performed to analyze the death causes, maternal death time and the influencing factors. Results The MMR declined from 27. 9 per 100 000 live births from 1995 to 2000 to 14. 8 per 100 000 live births from 2006 to 2010,with a decline of 46. 9％. Among the maternal death within 24 hours of delivery,79. 7％ (106/133) died of obstetric hemorrhage, hypertensive disorder complicating pregnancy and amniotic fluid embolism. It took up 47. 8％ (64/134) from 1995 to 2000,reduced to 37. 5％ (45/120) from 2006 to 2010. At the same time,the maternal mortality ratio within 24 hours reduced from 40. 2％ (54/134) to 28. 3％ (34/120) ,the variation of death time was consistent with the causes of maternal mortality( x2= 59. 109, P＜ 0. 05 ). Indirect obstetric causes increased significantly from 2006 to 2010,53.2％ (33/62) of pregnant women with heart disease,cerebrovascular disease and pulmonary embolism died in prenatal or more than 120 hours postnatal. Among the maternal death delved in hospital,29.0％ (29/100)died within 24 hours, 52 cases delved at home or in private clinics, 43 cases ( 82. 6％ ) died within 24 h postnatal. There were significant differences between birth place and death time ( x2 = 24. 500, P ＜ 0. 05 ).Conclusion Maternal death time changed from 24 hours of delivery to prenatal or postnatal a long time. The maternal mortality causes and hospital delivery is an important factor affecting maternal time.