10年围产儿死亡回顾分析

目的分析及探讨围产儿死亡原因,以提高围产保健的工作质量,降低围产儿死亡比.方法按照围产期I标准,对我院建院10年期间死亡围产儿245份住院病历进行统计分析.结果10年间围产儿死亡比11.31‰,死胎占55.92%,死产占8.16%,新生儿死亡占35.92%.导致围产儿死亡的主要并发症及死因为早产、胎儿畸形、妊娠并发症,死胎中以畸形、脐带因素为主,新生儿死亡以RDS及缺氧综合征为主.结论加强孕期监护,预防早产,防止并发症发生,是降低围产儿死亡比的主要措施.     

275例围产儿死亡原因分析

围产儿死亡率是评价一个国家和地区社会经济发展及卫生状况的重要指标之一,也是衡量围产保健水平的主要指标。为了解和掌握北京市海淀区妇幼保健院围产儿的死亡情况及影响围产儿死亡的相关因素,从而明确围产儿保健的重点并制订相应的干预措施,降低围产儿死亡率。     

围孕期优生优育咨询及保健

人口素质包括先天素质和后天素质，先天素质就是出生婴儿的质量，先天素质是后天素质的基础，要提高后天素质，必须先提高先天素质。因此，加强围孕期优生咨询和母婴保健就显得尤为重要。控制人口数量、提高人口素质是我国的基本国策，在控制人口数量的同时，提高人口素质亦不容忽视。我国是一个多民族国家，人口众多，生育基数大，地理环境复杂，各地区文化水平和经济条件相差悬殊，加上工农业发展，环境污染日益加重，严重影响着出生婴儿的质量。     

早产与围产儿死亡

对１９８１年１月～１９９５年３月在我院分娩的２９４例死亡围产儿进行了回顾性研究，其结果：围产儿死亡率为１３．３‰，尸检率７７．９％。早产儿共１６７例，占５６．８％。早产发生与产前出血、双胎、妊高征、ＩＵＧＲ、胎膜早破等因素有关。早产儿主要死亡原因顺位为：缺氧（４９．７％），肺部疾患（２３．９％），畸形（１１．４％），感染性疾病（５．４％），颅内出血（４．２％）。降低围产儿死亡率首先要防治早产。应加强围产期保健及监护，积极防治生殖道感染，加强早产的预测，合理使用宫缩抑制剂，监测并促进胎肺成熟。     

辽宁省围产儿病死率及死亡原因调查

辽宁省围产儿病死率及死亡原因调查辽宁省出生缺陷监测协作组（１１００１５）围产儿病死率常被用来衡量一个国家或一个地区的医学卫生、文化水平的重要指标。本文综合辽宁省１９８６年１０月到１９８７年９月１５所医院（部、省级医院２所、市级５所、县级４所、保健院２...     

Implementing a facility-based maternal and perinatal health care surveillance system in Afghanistan

Afghanistan has one of the highest maternal and perinatal mortality rates in the world. Lack of a health information system presented obstacles to efforts to improve the quality of care and reduce mortality. To rapidly overcome this deficit in a large women's hospital, staff implemented a facility-based maternal and perinatal surveillance system known as "BABIES," which is specially designed for intervention and evaluation in low-resource settings. During a 12-month period, 15,509 deliveries resulted in 28 maternal deaths and a perinatal mortality rate of 56 per 1000 births. When stratified by birth weight and perinatal period of death, fetuses weighing at least 2500 g who died during the antepartum period contributed the most cases of perinatal death. This finding suggests that the greatest reduction in perinatal mortality would be realized by increasing access to high-quality antepartum care. Among fetuses weighing at least 2500 g, 93 deaths occurred during the intrapartum period. These deaths will continue to be monitored to ensure that the chosen interventions are improving intrapartum care for mothers and newborns. Because of its simplicity, flexibility, and ability to identify interventions, BABIES is a valuable tool that enables clinicians and program managers to prioritize resources.     

Living in deprived urban districts increases perinatal health inequalities

Objective: Analyses of the effects of place of residence, socioeconomic status and ethnicity on perinatal mortality and morbidity in the Netherlands. Methods: Epidemiological analysis of all singleton deliveries > 22 gestational weeks (871,889 live born and 5927 stillborn) from the Dutch National Perinatal Registry 2002–2006. Multiple logistic regression analysis was used to determine whether place of residence (deprived neighborhood, or not) contributed to the adverse perinatal outcome (defined as perinatal mortality, preterm birth, small for gestational age, congenital abnormalities or Apgar score <7, 5?min after birth), additional to individual pregnancy characteristics, demographic characteristics, ethnic background and socioeconomic class. Results: Incidence of adverse perinatal outcome was 16.7%. After adjustment the excess risk for perinatal mortality in deprived districts was 21%, for preterm birth 16%, for small-for-gestational age 11%, and for Apgar score <7 after 5?min 11%. Conclusions: Perinatal inequalities appear impressive in both urban and nonurban areas, with a significant additive risk of living in a deprived neighborhood. Excess risk for perinatal mortality generally outranges that for morbidity, suggesting both an etiological and prognostic pathway for neighborhood effects. A distinct pattern exists for congenital anomalies, for which first trimester adverse selection effects may be responsible.     

A comparison of perinatal mortality in Korea on holidays and working days

OBJECTIVE: To examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays, and to elucidate its cause. DESIGN: Cross-sectional study. Setting Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea. POPULATION: In all, 628 485 births in 1999 in Korea. METHODS: Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors, the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression. MAIN OUTCOME MEASURE: Birthweight-adjusted perinatal mortality. RESULTS: Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR, Perinatal Mortality Rate, 16.4 versus 12.8; OR, 1.3; 95% CI, 1.2-1.4). After the adjustment of birthweight, gender, plurality and congenital anomalies, the odds ratio for death of infants born during holidays was 1.2 (95% CI, 1.1-1.3). CONCLUSIONS: The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care, rather than difference in case-mix.     

妊娠合并精神分裂症的孕期保健和围产期处理

妊娠合并精神分裂症是处理起来较棘手的问题.及早识别病例,加强围产保健,正确处理产程和决定分娩方式是处理的关键.应提供人文关怀,努力帮助患者得到婚姻、家庭及社会的支持.     

A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels

Objective: To evaluate the impact of a focused preconceptional and early pregnancy program specializing in the care of women with Type 1 diabetes on perinatal mortality and congenital malformations.

Methods: This clinical study included women with Type 1 diabetes in an interdisciplinary Diabetes in Pregnancy Program Project Grant (PPG) funded by the NIH (1978–1993); these women were enrolled preconceptionally or during the first trimester (up to 14 weeks) and had pregnancies continuing beyond 20 weeks gestation. Strict glucose control was implemented and adherence assessed. Antepartum fetal surveillance was started at 32 weeks gestation. All live-born infants and stillbirths were examined. A retrospective comparison analysis of the period before PPG I (1973–1978) and after cessation of funding (1993–1999) was performed, specifically evaluating perinatal mortality and congenital malformation rates. Data were analyzed using analysis of variance, χ², and Fisher's exact test.

Results: Three hundred and six women were enrolled in three 5-year periods: PPG I (1978–1983) n = 111, PPG II (1983–1988) n = 103, and PPG III (1988–1993) n = 92. Entry and interval glycohemoglobin A₁ concentrations obtained decreased with each consecutive PPG. An emphasis on preconception care began in 1984, with preconception enrollment reaching 23% for PPG II and increasing in PPG III to 37%. As preconception enrollment increased, perinatal mortality rate decreased from 3% for PPG I and 2% for PPG II, to 0% in PPG III, and the congenital malformation rate decreased to a low 2.2% by PPG III. Comparison data collected for the period before PPG I (1973–1978) n = 79 revealed a perinatal mortality rate of 7% and a congenital malformation rate of 14%. Also, a postprogram retrospective analysis of the period 1993–1999 (n = 82) revealed an increase in perinatal mortality, with one death compared to none in PPG III, and a congenital malformation rate of 3.65% compared to 2.2% during PPG III. The preconception enrollment for this period decreased (19.5%).

Conclusions: A program emphasizing preconceptional care, strict glycemic control preconceptionally and throughout gestation, and the use of antepartum fetal surveillance was associated with a significant decrease in the rate of perinatal mortality and congenital malformations in infants of women with Type 1 diabetes. However, ongoing improved outcome appears to depend on the availability of funding for a specialized preconception program.     

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.

Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.

Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p?=?.02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p?=?.02 and p?p?p?=?.02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p?=?.002), seizures (OR 4.33, 95%CI 1.60–11.77, p?=?.004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p?=?.049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p?Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.     

Hypertension during pregnancy in South Australia, part 2: risk factors for adverse maternal and/or perinatal outcome - results of multivariable analysis

OBJECTIVE: To identify factors associated with adverse pregnancy outcomes among women with hypertension during pregnancy. DESIGN: A population-based retrospective multivariable analysis using the South Australian perinatal data collection. METHODS: Perinatal data on 70,386 singleton births in 1998-2001 were used in multivariable analyses on three groups: all women combined, all hypertensive women and women with pregnancy hypertension only, in order to identify independent risk factors for requirement for level II/III care, preterm birth, small for gestational age (SGA) birth and maternal length of stay greater than 7 days. RESULTS: The risks for the four morbidities were all increased among women with hypertension compared with normotensive women. Those with pre-existing hypertension had the lowest risk (with odds ratios (OR) 1.26-2.90). Pregnancy hypertension held the intermediate position (OR 1.52-5.70), while superimposed pre-eclampsia was associated with the highest risk (OR 2.00-8.75). Among women with hypertension, Aboriginality, older maternal age, nulliparity and pre-existing or gestational diabetes increased the risk for level II/III nursery care, preterm birth and prolonged hospital stay. Smokers had shorter stays, which may be related to their decreased risk of having a Caesarean section or operative vaginal delivery. Asian women, Aboriginal women, smokers and unemployed women had an increased risk for having an SGA baby, while women with pre-existing or gestational diabetes had a reduced risk. CONCLUSIONS: Among hypertensive pregnant women, nulliparity, older maternal age, Aboriginality, unemployment and diabetes are independent risk factors for one or more major adverse pregnancy outcomes. Smoking does not always worsen the outcome for hypertensive women except for SGA births.     

Making pregnancy safer in Australia: the importance of maternal death review

Australia is one of the safest countries in the world to birth. Because maternal deaths are rare, often the focus during pregnancy is on the well-being of the fetus. The relative safety of birth has fostered a shift in the focus of maternal health, from survival, to the model of care or the birth experience. Yet women still die in Australia as a result of child bearing and many of these deaths are associated with avoidable factors. The purpose of this paper is to outline the maternal death monitoring and review process in Australia and to present to clinicians the salient features of the most recently published Australian maternal death report. The notion of preventability and the potential for practice to have an effect on reducing maternal mortality are also discussed.     

107例围产儿死因分析及干预研究

目的：分析107例围产儿的死亡率及死亡原因,探讨相应的干预措施,为降低围产儿死亡率提供科学依据。方法：按照围产期I标准,对我院2008年1月至2013年12月6年期间的107例围产儿的死因进行回顾性分析,提出干预措施。结果：6年间围产儿数为14340例,死亡107例。围产儿死亡率为7.46‰,其中2011年死亡率最高于9.92‰,2013年死亡率较低,为3.88‰。2013年与2008年相比差异有统计学意义（P〈0.05）。导致围产儿死亡的主要原因是先天畸形、早产低出生体重、母亲疾病。流动孕产妇围产儿死亡率明显高于本市孕产妇。结论：加强三级妇幼保健网的建设和孕期保健,减少出生缺陷,做好高危孕产妇的管理,尤其是流动人口孕产妇的管理,对妊娠合并症和并发症及早发现,制定有针对性的干预措施,是降低围产儿死亡率的主要而有效的途径。