新疆昌吉地区10年围产儿死亡原因分析及对策

目的分析围产儿的死亡原因,提出预防措施,提高围产医学质量,降低围产儿死亡率。方法回顾性总结2000年～2009年共73例围产儿死亡的临床资料,分析比较其死亡的主要原因。结果 10年总分娩人数6452人,围产儿死亡73人,死亡率11.31‰,死亡原因排前三位的依次为早产、畸形、新生儿窒息。结论加强优生优育教育,进一步提高产前诊断水平、产儿科诊治水平,是降低围产儿死亡率的关键。     

The obstetric implications of teenage pregnancy

A retrospective review was performed on the obstetric outcome of teenage pregnancies delivered in 1 year in a tertiary centre. The results were compared with the rest of the obstetric population in the same hospital in the same year. The teenage mothers (n = 194) had increased incidence of sexually transmitted diseases (5.2 versus 1.0%, P < 0.05), and preterm labour (13.0 versus 7.0%, P < 0.01), but decreased incidence of gestational glucose intolerance (3.1 versus 11.4%, P < 0.001), when compared with the non-teenage mothers (n = 4914). There was no difference in the types of labour, while the incidence of Caesarean section was lower (4.1 versus 12.6%, P < 0.001) in the teenage mothers. Although the incidence of low birthweight was higher in the teenage mothers (13.5 versus 6.5%, P < 0.001), there was no significant difference in the mean birthweight, gestation at delivery, incidence of total preterm delivery, or perinatal mortality or morbidity. The results indicate that the major risk associated with teenage pregnancies is preterm labour, but the perinatal outcome is favourable. The good results accomplished in our centre could be attributed to the free and readily available prenatal care and the quality of support from the family or welfare agencies that are involved with the care of teenage mothers.      

Home deliveries in Holland: Dutch maternity care and home confinements *

In the Netherlands a majority of all deliveries take place at home. The perinatal mortality rate is better than that reported from the United ffiingdom, probably because obstetric care in hospital is more active and aggressive. Dutch midwives play an important role and the specially trained home helps are most successful. I believe that, provided case selection is rigorous, many women are best delivered at home.     

Obstetric outcome with low molecular weight heparin therapy during pregnancy

This was a prospective study of women attending a combined haematology/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.     

An analysis of 3,199 patients booked for delivery in general-practitioner obstetric units

The outcome of 3,199 women booked for delivery in six general-practitioner obstetric units in one year was analyzed.

Five per cent cancelled their bookings, 26 per cent were transferred to a consultant unit after referral for routine problems of pregnancy (mainly postmaturity), and 14 per cent were transferred for problems arising in labour (principally uterine inertia). One per cent were transferred after confinement.

Fifty-four per cent were delivered successfully in the general-practitioner units.

There were 3,037 live births, 27 stillbirths and 22 neonatal deaths. Nine stillbirths and nine neonatal deaths resulted from congenital abnormalities, while two stillbirths and 11 neonatal deaths were due to immaturity. There were 25 sets of twins and one set of triplets. Seventy-five babies were abnormal, 105 weighed less than 2,500g, and 198 over 4,000g.

In this series almost 60 per cent of eventual perinatal deaths were transferred during pregnancy, and over 85 per cent before delivery.

The perinatal mortality of all women initially booked for a general-practitioner unit who delivered was 15·. The perinatal mortality of the 1,795 births in the six general-practitioner obstetric units was 3·9.

     

A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Perinatal and Reproductive Research.

BACKGROUND. It is often suggested that psychological and social support and health education for women at high risk for delivering a low-birth-weight infant can improve the outcomes of pregnancy, but the evidence is inconclusive. We undertook this prospective trial to evaluate a program of home visits designed to provide psychosocial support during pregnancy. METHODS. At four centers in Latin America, 2235 women at higher-than-average risk for delivering a low-birth-weight infant were recruited before the 20th week of pregnancy. The women were randomly assigned either to an intervention group (n = 1115) that received four to six home visits from a nurse or social worker in addition to routine prenatal care or to a control group (n = 1120) that received only routine prenatal care (with a mean of eight prenatal visits). The principal measures of outcome were low birth weight (< 2500 g), preterm delivery (< 37 weeks of gestation), and specified categories of maternal and neonatal morbidity. RESULTS. The women who received the home visits as well as routine prenatal care had outcomes that differed little from those of the women who received only routine care. The risks of low birth weight (odds ratio for the intervention group as compared with the control group, 0.93; 95 percent confidence interval, 0.68 to 1.28), preterm delivery (odds ratio, 0.88; 95 percent confidence interval, 0.67 to 1.16), and intrauterine growth retardation (odds ratio, 1.08; 95 percent confidence interval, 0.83 to 1.40) were similar in the two groups. There was no evidence that the intervention had any significant effect on the type of delivery, the length of hospital stay, perinatal mortality, or neonatal morbidity in the first 40 days. There was no protective effect of the psychosocial-support program even among the mothers at highest risk. CONCLUSIONS. Interventions designed to provide psychosocial support and health education during high-risk pregnancies are unlikely to improve maternal health or to reduce the incidence of low birth weight among infants.     

Seroprevalence of human immunodeficiency virus among childbearing women. Estimation by testing samples of blood from newborns

Attempts to predict the course of the epidemic of acquired immunodeficiency syndrome (AIDS) have been hampered by the lack of an objective, practical way to estimate the prevalence of infection with the human immunodeficiency virus (HIV) in the general population. Testing for the prevalence of HIV infection in women should be a sensitive means to track the epidemic and to study the potential for perinatal transmission. Antibodies in maternal blood are contained in neonatal blood specimens routinely collected on absorbent paper for other purposes, such as screening for phenylketonuria; we therefore tested for HIV antibody in these specimens. Analysis of batches of individually blinded specimens from selected hospitals protected the anonymity of the mothers and babies and was cost efficient. Using the newborn's blood as an indicator of the mother's serologic status, we concluded that 1 of every 476 women (2.1 per 1000) giving birth in Massachusetts was positive for HIV antibody by immunofluorescence assay or enzyme-linked immunosorbent assay, both confirmed by immunoblot (Western blot) testing. The prevalence of HIV infection varied according to the type and location of the maternity hospitals; rates of seropositivity were highest in inner-city hospitals (8.0 per 1000), lower in mixed urban and suburban hospitals (2.5 per 1000), and lowest in suburban and rural hospitals (0.9 per 1000). This method is useful for collecting data needed to plan and evaluate prevention strategies and to predict the health care resources that will be needed to care for women and children who contract AIDS. Because other states have newborn screening programs similar to the Massachusetts program, this approach can be used for national surveillance of AIDS in women.     

Decline in perinatal HIV transmission in New York State (1997-2000)

BACKGROUND: Perinatal HIV transmission has declined significantly in New York State (NYS) since implementation of a 3-part regimen of zidovudine prophylaxis in the antenatal, intrapartum, and newborn periods. This study describes the factors associated with perinatal transmission in NYS from 1997 to 2000, the first 4 years of NYS's comprehensive program in which all HIV-exposed newborns were identified through universal HIV testing of newborns. METHODS: This population-based observational study included all HIV-exposed newborns whose infection status was known and their mothers identified in NYS through the universal Newborn HIV Screening Program (NSP) from February 1997 to December 2000. Antepartum, intrapartum, newborn, and pediatric medical records of HIV-positive mothers/infants were reviewed for history of prenatal care, antiretroviral therapy (ART), and infant infection status. Risks associated with perinatal HIV transmission were examined. RESULTS: Perinatal HIV transmission declined significantly from 11.0% in 1997 to 3.7% in 2000 (P < 0.05). Prenatal ART was associated with a decline in perinatal HIV transmission both for monotherapy (5.8%, relative risk [RR] = 0.3, 95% confidence interval: 0.2%-0.5%) and combination therapy [2.4%, RR = 0.1, 95% confidence interval: 0.1%-0.2%) compared with no prenatal antiretroviral prophylaxis (P < 0.05). CONCLUSIONS: Public health policies to improve access to care for pregnant women and advances in clinical care, including receipt of appropriate preventive therapies, have contributed to declines in perinatal HIV transmission in NYS.     

Perinatal and maternal outcomes in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina

Aim

To compare perinatal and maternal outcomes in Tuzla Canton during the 1992-1995 war in Bosnia and Herzegovina with those before (1988-1991) and after (2000-2003) the war.

Methods

We retrospectively collected data on a total of 59 707 liveborn infants and their mothers from the databases of Tuzla University Department for Gynecology and Obstetrics and Tuzla Institute for Public Health. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age, and birth weights were collected. We also collected data on the number of medically unattended deliveries, examinations during pregnancy, preterm deliveries, and causes of maternal deaths. Perinatal and maternal outcomes were determined for each study period.

Results

There were 23 194 live births in the prewar, 18 302 in the war, and 18 211 in the postwar period. Prewar perinatal mortality of 23.3 per 1000 live births increased to 25.8 per 1000 live births during the war (P<0.001), due to a significant increase in early neonatal mortality (10.3‰ before vs 15.1‰ after the war, P<0.001). After the war, both perinatal mortality (14.4‰) and early neonatal mortality (6.6‰) decreased (P<0.001 for both). The most frequent cause of early neonatal death during the war was prematurity (55.7%), with newborns most often dying within the first 24 hours after birth. During the war, there were more newborns with low birth weight (<2500 g), while term newborns had lower average body weight. Women underwent 2.4 examinations during pregnancy (5.4 before and 6.3 after the war, P<0.001 for both) and 75.9% had delivery attended by a health care professional (99.1% before and 99.8% after the war; P<0.001 for both). Maternal mortality rate of 65 per 100 000 deliveries during the war was significantly higher than that before (39 per 100 000 deliveries) and after (12 per 100 000 deliveries) the war (P<0.001 for both).

Conclusion

Perinatal and maternal mortality in Tuzla Canton were significantly higher during the war, mainly due to lower adequacy and accessibility of perinatal and maternal health care.Perinatal outcome is the measure of the quality of perinatal care given to the mother and child before, during, and after delivery. Although perinatal care amounts to only 0.5% of the total health care an average person receives in a lifetime, this type of care is crucial for general health later in life and a is good indicator of the health of the pediatric population (1-3). More deaths occur in the perinatal period than in the first 30 years of life, and this death rate depends on the organization, availability, quality, and level of the development of perinatal care (4). According to the World Health Organization (5), there are about 7 million perinatal deaths in the world per year, with perinatal death rates ranging from 4-7 per 1000 live births in developed countries, 39 per 1000 in South America, 53 per 1000 in Asia, to 75 per 1000 in Africa. Every year, approximately 600 000 women die of pregnancy-related causes (6).Before the 1992-1995 war in Bosnia and Herzegovina, primary health care was provided in health centers and their outpatient facilities, secondary health care in general and regional hospitals and only partially in health care centers (specialized counseling), and tertiary health services were provided in medical centers, which were also university teaching hospitals (7). Perinatal care in Bosnia and Herzegovina had not been provided at the primary health care level, mostly due to insufficient perinatal knowledge and clinical skills of primary care physicians and other staff, and a lack of adequate equipment and space. Thus, in addition to tertiary health care, secondary health care, which was easily accessible, provided most of health care services to pregnant women, women giving birth, and newborns (7).All deficiencies of the health care system organization in Bosnia and Herzegovina became obvious during the war period. Regular examinations during pregnancy could not be performed at any level of health care, health care at birth was inadequate, and neonatal health care was almost non-existent. Many hospital systems and the existing equipment were damaged or destroyed in war (8), shortage of medicines was evident, and a large proportion of health care staff either left the country or was needed on the battlefield. The existing hospital facilities were overcrowded with the wounded and patients with chronic diseases. The whole health care system was adapted to war circumstances. Perinatal care in Bosnia and Herzegovina rapidly deteriorated. Furthermore, there was massive migration of the population due to the war and some parts of the country, such as Tuzla Canton, were overburdened with a large number of refugees and displaced persons (8).The aim of this study was to determine how increased inaccessibility of perinatal and maternal health care during the war reflected on perinatal and maternal outcomes in Tuzla Canton, Bosnia and Herzegovina.     

The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan

Black infants are born with low birth weights (less than 2500 g) and very low birth weights (less than 1500 g) at twice the rate of white infants. We investigated the effect of prenatal care delivered in a health maintenance organization on the birth weights of black and white infants at normal risk for low birth weight. Using birth certificates for all children born in 1978 in the California Kaiser-Permanente hospitals, we studied data on more than 31,000 black and white newborns whose mothers' ages and levels of education were comparable. The data show that black mothers used prenatal care less extensively and had a higher incidence of infants with low birth weights (8.4 vs. 3.6 percent) and very low birth weights (2.0 vs. 0.7 percent) than white mothers. The difference in the use of prenatal care, however, accounted for less than 15 percent of the difference in the incidence of low birth weight. The rates of low birth weight, very low birth weight, and preterm birth (less than 260 days' gestation) decreased with increasing levels of prenatal care for both blacks and whites. However, increasing levels of care were associated with a greater reduction among black infants than among white infants in low birth weight, very low birth weight, and low birth weight at term (greater than or equal to 260 days' gestation). When we compared mothers who received adequate care with those who received inadequate care, the relative risk of giving birth to a very-low-birth-weight infant was reduced 3.6-fold (95 percent confidence interval, 2.0 to 6.6) for black mothers and 2.1-fold (confidence interval, 1.3 to 3.4) for white mothers; the relative risk of giving birth to a low-birth-weight infant at term was reduced 3.4-fold (95 percent confidence interval, 2.2 to 5.4) for black mothers and 1.6-fold (confidence interval, 1.1 to 2.3) for white mothers. We conclude that even in a population of women at low risk for giving birth to low-birth-weight infants, prenatal care is more beneficial for blacks than for whites.     

Obstetric profiles and pregnancy outcomes of immigrant women with refugee status

This paper describes the obstetric profiles and pregnancy outcome of immigrant women with refugee status. A retrospective analysis of two hundred and seventy one immigrant women with confirmed refugee status who delivered in our hospital between June 1999 and May 2000 was performed. The average gestational age at booking was 33 weeks. The majority (63%) were multiparous, had low rates of epidural analgesia, instrumental delivery and episiotomies. There were no differences in the gestational age at delivery, incidence of caesarean section and birth weights from the hospital population. In this small study group there were four perinatal deaths giving a corrected perinatal mortality of 14.8 compared to 5.6 in the hospital population. Seven patients (3%) tested positive for Human Immunodeficiency Virus (HIV). Two patients (0.8%) were diagnosed with active tuberculosis. The majority of patients (80%) were living in emergency accommodation. In conclusion, this population has specific obstetric, medical and social problems.     

129例畸形子宫妊娠结局临床分析

目的 了解畸形子宫妊娠对母婴的影响.方法 对我院2001年1月至2005年12月五年间收治的129例畸形子宫妊娠进行回顾性分析.结果 资料显示其发病率为1.03%.129例畸形子宫总妊娠数356次,足月产占59.33%,其中剖宫产占51.59%.新生儿窒息及死亡共占16.96%.结论 畸形子宫分娩期并发症多,手术产率高,应尽早明确诊断,加强孕期管理及产时监护.     

Increasing trend of Cesarean deliveries in HIV-infected women in the United States from 1994 to 2000

BACKGROUND: Meta-analysis and randomized clinical trial results reported in June 1998 indicated a significant reduction in perinatal HIV transmission rates among mothers undergoing a cesarean section (C-section). OBJECTIVE: The objective of this study was to examine recent trends in and factors associated with C-section deliveries among HIV-infected women in the United States. DESIGN: A multisite pediatric medical record review of a cohort of HIV-exposed and HIV-infected infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort study (n = 6467) and the national Pediatric HIV/AIDS Reporting System (HARS) (n = 8,306) was conducted. SETTING/PATIENTS: All infants born between 1994 and 2000 to HIV-positive mothers referred to the PSD study or to a Pediatric HARS hospital or clinic site were enrolled. RESULTS: The proportion of deliveries by C-section was steady at about 20% from 1994 through June 1998. From July 1998 through December 2000, this proportion increased to 44% in the PSD study and to nearly 50% in the Pediatric HARS. On analysis by multiple logistic regression, delivery of infants by C-section was associated with the release of study results (OR = 2.83), delivery in four PSD sites in reference to Texas (OR: 2.02-1.43), having private medical care reimbursement (OR = 1.62), and having maternal prenatal care (OR = 1.43). CONCLUSIONS: The PSD and Pediatric HARS data demonstrate a sharp increase in C-section rates mainly among HIV-infected women in the United States after the release of the meta-analysis and randomized clinical trial results in 1998. This finding highlights the rapid impact of study results on obstetric practice. It underscores the critical role of prenatal care in offering perinatal interventions such as scheduled C-section when indicated to reduce the likelihood of HIV transmission.     

Association between Short Maternal Height and Low Birth Weight: a Hospital-based Study in Japan

Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0–151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0–157.9 cm) and the third shortest maternal height quartiles (158.0–160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn’s small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission.     

Perinatal outcome after in-vitro fertilization-surrogacy

The perinatal outcome of pregnancies (both single and multiple) established after in-vitro fertilization (IVF)-surrogacy was evaluated and compared to the outcome of pregnancies that resulted from standard IVF. Analysis of medical records and a telephone interview with physicians, IVF-surrogates, and commissioning mothers were conducted to assess prenatal follow up and delivery care in several hospitals. 95 IVF-surrogates delivered 128 liveborn (65 singletons, 27 sets of twins and two sets of triplets). The commissioning mothers and the IVF-surrogates average ages were 37.7 +/- 5.0 and 30.4 +/- 4.7 years old respectively. IVF-surrogates carrying twin and triplet gestations delivered substantially earlier than those who gestated singleton pregnancies (36.2 +/- 0.4 versus 35.5 versus 38.7 +/- 0.3 weeks gestation respectively; P < 0.001). Twin newborns were significantly lighter than singleton infants born through IVF-surrogacy (2.7 +/- 0.06 versus 3.5 +/- 0.07 kg; P < 0.001). The incidence of low birth weight infants rose from 3.3% in the single births to 29.6% (P < 0.01) in the twins and to 33.3% in the triplets born through IVF-surrogacy. The incidence of prematurity was significantly greater in both twins delivered by IVF-surrogates (20.4%) and infertile IVF patients (58%). The occurrence of pregnancy-induced hypertension and bleeding in the third trimester was four to five times lower in the IVF-surrogates, independently of whether they were carrying multiples. The incidence of Caesarean section was 21.3% for singleton gestations, while two times higher in the IVF-surrogates carrying multiples (56.3%). Postpartum complications occurred in 6.3% of patients and the incidence of malformation was similar to those reported for the general population. The results provide general reassurance regarding perinatal outcome to couples who wish to pursue IVF-surrogacy.     

Pregnancy outcomes among Whites and Filipinos: A paradoxical birth weight-neonatal mortality relationship

Evidence from the Philippines suggests that, compared to Whites, infants born to Filipino women are more likely to be low birth weight. A paucity of information is available regarding birth outcomes of U.S.-born Filipinos. Using 1979–1987 Hawaii vital record data on single live births to resident mothers, this study compares the maternal characteristics and pregnancy outcomes of White and Filipino mothers, Filipino mothers were significantly more likely to be <18 years of age and single, and have lower educational attainment and less adequate utilization of prenatal care. Significantly higher percentages of very preterm, preterm, very low birth weight, low birth weight, and small for gestational age infants were found for Filipinos. The birth weight-specific neonatal mortality rates for Filipinos compared favorably to Whites except at the high end of the birth weight distribution. After taking into account maternal sociodemographic risk and prenatal care factors in a logistic regression, a significant ethnic difference in low birth weight persisted but was not found for neonatal mortality. These data may suggest that similar neonatal mortality rates among ethnic groups may be possible in the face of persistent birth weight distribution differences and add to the growing evidence that a single standard of low birth weight may be inappropriate as an universal indicator of health status risk in a multi-ethnic population. © 1993 Wiley-Liss, Inc.     

Sex Differences in the Association between Prenatal Smoking and Decreased Birthweight,and Intensive Health Care of the Neonate

Gender-specific associations between prenatal smoking and birthweight, and neonate intensive health care were studied. Cross-sectional data from 11,583 newborns in the continuous National Health and Nutrition Examination Survey (NHANES) 2003–2008 early childhood data sets were used. Change in infant birthweight and likelihood of receiving neonatal intensive care by prenatal smoking exposure were assessed. Multivariable regression models were used to assess the influence of prenatal smoking on birthweight and likelihood of receiving intensive neonatal health care. Compared with infants from nonsmoking mothers, prenatal smoking associated with significant decrease in infant birthweight, ?203.0 g ± 32.5, P < 0.001. The change in birthweight differed between infant boys, ?220.2 g ± 44.5, and girls, ?184.1 g ± 38.8. Newborns exposed to prenatal smoking were more likely to have low birthweight, odds ratio 1.46, P < 0.03, and to receive neonatal intensive health care, odds ratio 1.20; P < 0.04. It is imperative that prenatal counseling emphasizes prenatal maternal smoking.     

The cost effectiveness of stopping preterm labor with beta-adrenergic treatment

We retrospectively compared the costs of maternal and neonatal medical care after beta-adrenergic drug treatment, given to arrest preterm labor, with expected costs associated with no gestational delay. The treatment arrested labor for at least three days in 61 per cent of patients; gestation was extended by 14.1 +/- 1.1 weeks (mean +/- S.E.M.) in infants with the earliest gestational age at treatment (20 to 25 weeks) and by 2.3 +/- 0.7 weeks in those with the latest gestational age (36 to 37 weeks). Costs were based on hospital charges and physicians' fees, including high-risk obstetric outpatient charges, obstetric prenatal and delivery inpatient charges, and pediatric inpatient charges. Treatment provided between 26 and 33 weeks of gestation was clearly cost effective, resulting in expected savings of $11,240 (1981 dollars) per birth. After 33 weeks there was no substantial difference in expected costs with or without treatment. Between 20 and 25 weeks of gestation, the expected costs per surviving infant were $39,000 lower with treatment; however, the number of mothers who were not treated at this early stage of gestation (three patients) was too small to permit statistical significance. When the improved survival of infants after prenatal treatment was taken into account, treatment before 25 weeks was also cost effective. Thus, the increased costs of prenatal medical care were offset by decreased costs of neonatal medical care when treatment was given before 34 weeks of gestation.     

妊娠肝病围产儿死亡80例临床分析

目的：探讨妊娠肝病围产儿死亡的相关因素，对这一高危人群的围产期管理提出可行性建议和措施。方法：对1991年1月－2000年12月在我院诊断为妊娠肝病患者的围产儿死亡80例进行回顾性分析。结果：10年间我院肝病孕妇的围产儿死亡率为17．99‰，而且以死胎为主，占65．00％。围产儿死亡有性别差异，男性死亡率为21．64‰，显著高于女性死亡率10．11‰（P＜0．01）。前后5年比较围产儿死亡率无显著下降（P＞0．05），其中本市城区和郊区的围产儿死亡率有下降趋势，而外来人口围产儿死亡率有上升趋势。母体患重型病毒性肝炎、慢性乙型肝炎和妊娠急性脂肪肝（AFLP）者，围产儿死因主要为妊高征和胎儿及新生儿窒息。母体HBV携带者围产儿死因主要为脐带因素、胎膜早破和窒息。结论：妊娠肝病可使围产儿死亡率明显增加，其导致围产儿死亡的根本原因是重症肝病引起的妊高征和胎儿宫内缺氧。外来人口、男性胜儿等是围产儿死亡的高危因素。加强对肝病孕妇特别是外来人口的孕期管理，积极治疗肝病，必要时尽早终止妊娠，提高产时处理及新生儿复苏水平是降低妊娠肝病围产儿死亡率的关系。     

广州市白云区2001年～2010年围产儿死亡分析及干预措施

目的对广州市白云区围产儿死亡相关因素进行分析和总结,探讨围产儿死亡率的变化及其影响因素,为降低围产儿死亡率制定相关的干预措施提供科学依据。方法回顾性分析广州市白云区2001年～2010年共10年间围产儿死亡评审资料。结果共有1653例围产儿死亡,平均死亡率为7.98‰,其中户籍人口为5.4‰,流动人口为8.8%（χ2=57.432,P〈0.001）;围产儿死亡率呈逐年下降趋势。影响围产儿死亡的因素有：覆盖全民的医疗保障系统不全面、产、儿科诊疗知识技能和医疗系统管理存在薄弱环节、孕期保健意识薄弱,围产保健管理有待加强。结论通过加强政府投入,建立健全孕产妇三级网络保健系统,特别加强对农村地区和流动人口的孕产妇管理;提高医疗机构产、儿科诊疗技能水平;提高产前诊断技术,减少出生缺陷;加强流动人口管理等措施,有效降低围产儿死亡率。