1999～2008年上海市早期新生儿死亡原因分析

目的:探讨1999～2008年上海市早期新生儿死亡原因及存在主要问题,为进一步降低围产儿死亡率提供参考。方法:回顾性分析1999～2008年上海市产科工作情况报表及上海市围产儿死亡、出生缺陷登记表的相关资料。结果:①1999～2008年上海市共死亡早期新生儿2336例,死亡率为2.00‰,其中本市户籍死亡率1.27‰、非本市户籍死亡率2.86‰。②本市户籍第一位死因为严重畸形占26.56%,其后依次为早产、产时窒息、宫内窘迫及肺透明膜病;非本市户籍第一位死因为早产占19.75%,其后依次为严重畸形、产时窒息、肺透明膜病及宫内窘迫。③本市户籍早期新生儿前后5年死因顺位的主要变化为"产时窒息"明显下降,后5年的死亡构成较前5年下降53.61%,而死亡专率下降77.78%。非本市户籍的死因顺位主要变化为"宫内窘迫"由第5位上升到第4位,死亡构成较前5年上升6.52%,死亡专率下降44.00%。结论:加强对外来流动人口的围产期保健管理,并针对产前诊断、早产管理、新生儿窒息复苏等采取有效措施,降低早期新生儿死亡率、提高围产保健质量。     

杭州市萧山区2001-2005年围产儿死亡状况调查

目的探讨围产儿死亡原因,以提高围产保健质量,提高出生人口素质。方法对2001-2005年的442例围产儿死亡资料进行回顾性调查分析。结果5年围产儿死亡率为7.86‰,死胎、死产、早期新生儿死亡率分别为4.78‰、0.36‰、2.72‰,其构成比分别为60.9%、4.5%、34.6%。死胎、死产、早期新生儿死亡的第一位原因分别为胎儿畸形、脐带或胎盘异常、早产。结论提出要进一步降低萧山区围产儿死亡率,关键是有效地控制先天畸形的发生和出生。     

1991至2015年上海市围产儿死亡情况分析

目的 通过对上海市1991至2015年近25年围产儿死亡个案进行分析,了解围产儿死亡趋势、原因,总结经验,为探索进一步健全围产保健制度提供依据.方法 回顾性分析1991至2015年上海市围产儿死亡个案,分析死亡趋势、特征及死因.结果 ①近25年围产儿死亡率平均为5.97‰,其中户籍人口平均为4.80‰,非户籍人口平均为7.41‰,近25年间围产儿死亡率逐年下降;②近25年围产儿死亡以非户籍为主,占55.45%,其母亲产次为2次以上的比例逐年上升,从18.80%升至40.76%,双胎死亡比例逐年缓慢上升,2010年开始超过10.00%,2015年达最高水平13.00%;③围产儿死亡中死胎、死产和早期新生儿死亡构成分别为53.35%、8.33%和38.32%,死产死亡构成和新生儿死亡构成逐年下降.死胎率从1991年的4.35‰下降到2015年的1.85‰(χ2=732.383,P=0.000),死产率从1991年的1.18‰下降到2015年的0.12‰(χ2=879.183,P=0.000),新生儿死亡率从1991年的4.90‰下降到2015年的1.18‰(χ2=2 040.316,P=0.000);④围产儿死亡原因顺位中前四位分别为早产儿、严重畸形、宫内窘迫和原因不明,其中先天畸形比例占死亡总数的12.63%.结论 上海市围产儿死亡率处于中等发达国家水平,与上海市近20年的孕产期保健措施密不可分,为了进一步控制围产儿死亡率,需加强出生缺陷三级预防、提高孕产妇保健精细化管理和人才培养.     

上海市1999～2008年围产儿死亡情况分析

目的:分析上海市围产儿死亡现状,探讨围产儿死亡原因及相关因素,为改进围产期保健提供科学依据。方法:回顾性分析1999～2008年上海市全部围产儿死亡个案及评审资料。结果:①1999～2008年围产儿平均死亡率为6.0‰,从1999年的7.3‰下降至2008年的4.8‰。其中本市户籍围产儿死亡率从4.9‰下降到2.8‰,非本市户籍者从14.9‰下降至6.3‰。②围产儿死因前5位依次为原因不明(13.8%)、严重畸形(12.8%)、早产儿(6.7%)、宫内窘迫(6.5%)和脐带缠绕(5.7%)。③非本市户籍围产儿死亡者高危孕妇比例高(49.1%)、高龄产妇多(12.0%)、经产妇多(45.7%)、无产前检查者多(47.6%)。④评审结果显示,可以避免死亡占2.6%、创造条件可以避免死亡占16.4%、不可避免死亡占81.0%。结论:上海市围产儿死亡率较低,但仍有下降空间。加强流动人口孕产妇管理、减少畸形和早产是关键。     

49例围产儿死亡原因分析

目的:分析该院9年间围产儿死亡率及相关因素,以提高围产保健的工作质量,降低围产儿死亡率。方法:对该院1997～2005年围产儿死亡49例进行回顾性分析。结果:围产儿死亡率9.74‰,死胎占63.26%,死产占8.16%,早期新生儿死亡占28.57%。结论:加强产前监护,早期干预孕期并发症,预防早产及其并发症的发生,提高产科质量,是降低围产儿死亡率的关键。     

上海市2003—2008年流动人口围产儿死亡情况分析

【目的】研究上海市流动人口围产儿死亡状况,为制定干预措施提供依据。【方法】对2003—2008年上海市围产儿死亡情况进行回顾性分析。【结果】 1)2003—2008年上海市流动人口6年平均围产儿死亡率为8.46‰,本市户籍6年平均围产儿死亡率为3.18‰,流动人口围产儿死亡率明显高于本市户籍人口(P0.01);2)2003—2008年流动人口围产儿死亡率呈下降趋势,且下降幅度较大,尤其是2004—2005年下降幅度最大。而本市户籍人口围产儿死亡率总体虽呈下降趋势,但有一定波动性,2006年较上一年略有上升;3)2003—2008年全市围产儿死亡原因排在前六位的有:原因不明、严重畸形、早产儿、宫内窘迫、脐带因素、胎盘早剥;4)流动人口2006—2008年Ⅰ类(可能避免)死亡所占比例有所增加,而本市户籍Ⅰ类(可能避免)死亡所占比例明显减少。【结论】流动人口围产儿死亡率下降空间大,要重视流动人口围产儿死亡率的干预。     

浦东新区南汇地区2004～2009年围产儿死亡情况分析

目的:降低浦东新区南汇地区的围产儿死亡率,提高出生人口质量,维护母婴健康。方法:选择上海浦东新区南汇地区2004～2009年的围产儿死亡病例进行分析评审。结果:2004～2009年平均围产儿死亡率为4.78‰,死胎、死产及新生儿死亡分别占59.69%、16.75%和23.56%。结论:分析死亡原因及评审结果并进行相关讨论,可提出相应措施,进一步有效地降低浦东新区南汇地区围产儿死亡率。     

象山县2005～2010年围产儿死亡监测分析

目的:进一步了解象山县围产儿死亡率、死亡原因及相关因素,为提高围产保健质量制定干预措施。方法:根据浙江省围产儿死亡监测方案对各分娩单位上报的313例围产儿死亡个案进行调查分析及评审。结果:2005～2010年象山县围产儿死亡率9.31‰,其中死胎占63.90%、死产占4.15%、早期新生儿死亡占31.95%。死因及顺位分别是出生缺陷占41.21%、胎儿因素占15.02%、母亲疾病占10.22%、原因不明占9.90%、新生儿疾病占9.27%、脐带病变占7.99%、胎盘病变占6.39%。通过县级专家评审发现不可避免死亡占69.65%,创造条件可能避免死亡占24.60%,可以避免死亡占5.75%。结论:提高围产保健质量、产科质量及新生儿科水平,加强孕妇及家属的保健意识,普及产前筛查、产前诊断是降低围产儿死亡的关键。     

广州市海珠区555例围产儿死亡分析

目的:探讨围产儿死亡原因,提出相应对策,以提高围产保健工作质量,降低围产儿死亡率。方法:对海珠区2003年10月～2008年9月死亡围产儿555例住院病历进行回顾性分析。结果:5年内围产儿平均死亡率11.50‰,其中死胎占38.20%、治疗性引产占30.63%、早期新生儿死亡占23.60%及死产占7.57%。导致死胎的原因以脐带、胎盘因素为首位,胎儿畸形是治疗性引产的主要原因,分娩期并发症及胎儿因素是死产的两大原因,新生儿疾病是引起新生儿死亡发生的重要原因,后者与早产有密切关系。结论:加强孕期筛查及监护,避免早产,防止妊娠并发症的发生,强化管理流动孕产妇及贫困孕产妇的分娩救助等是降低围产儿死亡率的措施。     

86例围产儿死亡回顾性分析

目的:分析围产儿死亡原因,提高围产保健工作质量,降低围产儿死亡率。方法:按围产期标准,对2000年1月~2007年12月的86例死亡围产儿进行统计分析。结果:围产儿死亡率为9.82‰。其中新生儿死亡占25.58%,死胎占58.14%,死产占16.28%。新生儿死亡中先天畸形占40.91%,为新生儿死因之首;死胎中胎盘脐带因素占30.00%,为死胎主要原因;死产中早产较低体重儿占26.67%。结论:提高并充分利用产前诊断技术,加强孕期监护,做好孕期宣教,预防早产,防止并发症发生,是降低围产儿死亡率的主要措施。     

上海市推广新生儿窒息复苏技术对降低围产儿死亡率的效果

目的:分析上海市推广新生儿窒息复苏技术的效果,为进一步降低围产儿死亡率、改善新生儿的生存结局提供依据。方法:回顾性分析2005～2010年在上海市接产医院出生的新生儿窒息、死亡的情况。结果:①2005～2010年围产儿死亡率为5.04‰,新生儿死亡率为1.60‰;新生儿窒息发生率为1.56%,新生儿窒息死亡率为9.32‰。②后三年(2008～2010年)与前三年(2005～2007年)相比较,围产儿死亡率显著低于前三年,新生儿窒息发生率显著下降(P<0.01);非本市户籍者的新生儿死亡率及窒息死亡率均较前三年显著下降(P<0.05)。③产科医生、助产士的培训覆盖率和在实际参与窒息复苏抢救的应用中均高于新生儿科和儿科医生。结论:通过全覆盖规范培训所有与分娩相关的医务人员,可显著降低围产儿死亡率、新生儿死亡率及因新生儿窒息所导致的死亡。     

A Case Series Study of Perinatal Deaths at One Referral Center in Rural Post-conflict Liberia

The overall objective of this study was to further our understanding of the factors contributing to the high perinatal mortality rates at a busy rural, referral hospital in Liberia. The specific aims were to: (1) analyze the records of women who experienced a perinatal loss for both medical and nonmedical contributing factors; (2) describe the timing and causes of all documented stillbirths and early neonatal deaths; and (3) understand the factors surrounding stillbirth and early neonatal death in this context. This case series study was conducted through a retrospective hospital-based record review of all perinatal deaths occurring at the largest rural referral hospital in north-central Liberia during the 2010 calendar year. A record review of 1,656 deliveries identified 196 perinatal deaths; 143 classified as stillbirth and 53 were classified as early neonatal death. The majority of stillbirths (56.6 %) presented as antenatal stillbirths with no fetal heart tones documented upon admission. Thirty-one percent of cases had no maternal or obstetrical diagnosis recorded in the chart when a stillbirth occurred. Of the 53 early neonatal deaths, 47.2 % occurred on day one of the infant’s life with birth asphyxia/poor Apgar scores being the diagnosis listed most frequently. Clear and concise documentation is key to understanding the high perinatal death rates in low resource countries. Standardized, detailed documentation is needed to inform changes to clinical practice and develop feasible solutions to reduce the number of perinatal deaths worldwide.     

Five-decade international trends in the relation of perinatal mortality and congenital malformations: stillbirth and neonatal death compared.

The relation between long-term temporal trends in stillbirth and neonatal death rates and the congenital malformation frequencies in such deaths were analysed, using data from hospital-based European, USA, and Canadian reports published from 1950. In the last 50 years the overall perinatal mortality rate has fairly steadily improved, decreasing by 65-80%. This was accomplished by the control of some serious problems of early life. However, lingering disorders form an ever larger proportion of the causes of perinatal mortality. Among the prominent of these are congenital malformations, accounting for nearly 30% of perinatal deaths at present. However, this figure conceals important differences between stillbirths and early neonatal deaths. For example, although stillbirth and early neonatal mortality rates have decreased to similar extents during these years, congenital malformations, which were almost equally frequent causes of death in both of them at the beginning of this period, are now about twice as common in early neonatal (one week) deaths as in stillbirths. Other differences between them are in birthweight-related malformation frequencies and in characteristic arrays of malformations. The significance of these patterns and of some geographical variations, and the likelihood of continuing improvement in the stillbirth and early neonatal mortality rates are discussed.     

78例围产儿死亡原因分析及预防措施

目的:分析围产儿死亡原因,为提出干预措施,降低围产儿死亡提供科学依据。方法:按照围产期标准,对78例围产儿死亡进行回顾性分析。结果:围产儿10752例,死亡78例,围产儿死亡率7.25‰,其中死胎38例,占48.71‰;死产10例,占12.82‰;出生7d内新生儿死亡30例,占38.46‰,导致围产儿死亡的主要原因是胎儿畸形。结论:提高产前诊断技术,加强围产期监护,重点做好高危孕产妇的筛查与监护,积极治疗高危妊娠和高危新生儿,可降低围产儿死亡率。     

Mortality rates of children aged under five in Henan province,China, 2004–2008

Huo K, Zhao Y, Feng H, Yao M, Sävman K, Wang X, Zhu C. Mortality rates of children aged under five in Henan province, China, 2004–2008. Paediatric and Perinatal Epidemiology 2010. To analyse the mortality rates, causes of death and trends over time in children aged under five years in Henan province and to provide preventive advice to attempt to decrease the mortality rates of these children, a retrospective study was conducted, analysing the vital statistics data from 2004 to 2008 from the annual report of maternal and child health in Henan. The early neonatal (<7 days), neonatal (<28 days), infant (<1 year) and children under‐five mortality rates were calculated for each year. The child mortality rates decreased in all age groups (early neonatal, neonatal, infants and children <5 years) from 2004 (7.44‰, 9.81‰, 12.08‰ and 14.04‰, respectively) to 2008 (4.86‰, 5.50‰, 7.08‰ and 8.81‰, respectively). The changes were more pronounced in the rural areas. However, child mortality remained higher in the rural areas (5.00‰, 5.62‰, 7.22‰ and 9.06‰) than urban areas (3.98‰, 4.74‰, 6.21‰ and 7.30‰). Infants and neonates accounted for a large proportion of deaths in the under‐fives (84.5% and 67.9%). The first five leading causes of death in the under‐fives were: disorders relating to short gestation and low birthweight, birth asphyxia, congenital anomalies, accidents and pneumonia. The leading causes of death in different age groups varied between rural and urban areas. Reducing early newborn death, especially in the rural areas, is a key step to further decreasing mortality in the under‐fives. Attention should be paid to perinatal care to prevent preterm birth and congenital anomalies.     

Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries

OBJECTIVE: To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 pregnancies that ended after 28 weeks in nulliparous women. METHODS: A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam. We used the Baird-Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10). FINDINGS: Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births. Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths (62%). CONCLUSIONS: Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries.