2009-2011年湖南省计划外生育孕产妇死亡相关特征分析

目的分析2009-2011年湖南省计划外生育孕产妇死亡相关特征,寻找减少计划外生育孕产妇死亡的可控因素,为制定计划外生育人群系统保健工作策略及政策提供理论依据。方法通过湖南省三级妇幼保健网络收集湖南省2009-2011年的孕产妇死亡资料共572例。依据计划生育情况,将其中有记录569例孕产妇死亡个案分为计划生育内、外组,分析指标包括:孕产妇的人口社会学因素、孕期保健相关因素、分娩相关特征、死亡相关特征。结果计划外生育组与计划内生育组组间比较:计划外生育组孕产妇死亡中高龄(35岁及以上)和低龄(小于20岁)构成比显著增高(χ2=78.828,P=0.000);妊娠次数(χ2=60.319,P=0.000)和分娩次数明显增多(χ2=56.887,P=0.000);产检次数明显减少,尤其是孕期从未做过产前检查者明显增加(χ2=43.793,P=0.000);分娩地点级别低,尤其是在家中及其他非法接生机构分娩者增多(χ2=29.351,P=0.000);计划外组剖宫产终止妊娠者明显减少(χ2=16.624,P=0.000);死于产科出血等直接产科原因者明显增多(χ2=23.096,P=0.000);可避免死亡构成比明显增多(χ2=13.735,P=0.001)。二组间死亡孕产妇的城乡分布、家庭年人均收入、死亡地点分布等构成比差异无统计学意义(P0.05)。结论计划外生育死亡孕产妇特点是妊娠和分娩次数多、高龄或低龄妊娠、孕产期服务较差,产检次数少、分娩地点级别较低、产科出血等直接产科死因及可避免死亡构成比高。

Analysis on the characteristics of the maternal death with unplanned births in Hunan Province in 2009-2011

Objective To analyze the features of the maternal death with unplanned births in Hunan Province from 2009 to 2011, to explore the controllable factors and to provide theoretical evidence for formulating systemic health care strategies and 13ol- icies. Methods The data about 572 maternal deaths in Hunan Province during 2009 - 2011 were collected from the Three - level Network for Hunan Maternal and Child Health Care. According to family planning, 569 maternal death cases with complet- ed records were divided into planned birth group and unplanned birth group, and the index analysis included maternal demograph- ic and sociological factors, antenatal care - related factors, delivery- related features and maternal death features. Results There were statistically significant differences in the constitution of the age （ x2 = 78. 828, P = 0. 000）, times of pregnancy （ x2 = 60. 319, P = 0. 000）, times of delivery （ x2 = 56. 887, P = 0. 000）, obstetrical examinations （ x2 = 43. 793, P = 0. 000）, place of delivery （ x2 = 29. 351, P = 0. 000）, modes of delivery （ x2 = 16. 624, P = 0. 000）, deaths induced by direct obstetric causes （ x2 = 23. 096, P = 0. 000） and evitable deaths （ x2 = 13. 735, P = 0. 001） between planned birth group and unplanned birth group. No statistically significant difference was found in the distributions of maternal residence, per capita annual family income and the location of death between the two groups （P 〉 0.05）. Conclusions Maternal deaths with unplanned birth are characterized by repeated pregnancy and parturition, elderly or younger pregnancy, poorer maternal health care, fewer antenatal check- ups, parturition in low- level medical places and higher mortality induced by direct obstetric causes like obstetric hemor- rhage and evitable factors.