山东省1990～2001年孕产妇死亡动态变化趋势

目的 进一步降低孕产妇的死亡率,准确把握孕产妇死亡动态变化趋势,制定相应干预措施。方法对山东省1990～2001年孕产妇死亡监测资料及专家评审情况进行分析。结果12年来孕产妇死亡率下降明显。从1990年的54.71/10万下降到2001年的26.09/10万。孕产妇的死亡原因,产科出血和妊娠合并心脏病一直居首位和第3位;羊水栓由前6年的第5位上升为后6年的第2位;妊娠高血压综合征由前6年的第2位降为后6年的第4位。314例死亡孕妇中,农民269例,占85.67％。结论 农村孕产妇死亡比例仍然高居不下,应引起妇幼保健工作者的高度重视。进一步加强宣传,增强农村孕产妇自我保健意识,改善乡村医疗卫生条件,提高医务人员的知识技能,是降低孕产妇死亡率的主要途径。     

2001～2009年互助县农村孕产妇死亡相关因素探讨

目的 通过对孕产妇死亡资料的分析,探讨孕产妇死亡的因素,为制定干预措施提供依据.方法 对互助县2001～2009年度孕产妇死亡资料进行回顾性分析.结果 9年全县孕产妇死亡33例,平均死亡率为81.15/10万,孕产妇死亡原因第1位是产科出血,占36.59%.其它是内科合并症和妊娠高血压疾病、羊水栓塞.结论 应进一步加强...     

2004～2008年皮山县孕产妇死亡状况分析

孕产妇死亡率是衡量一个国家社会经济发展的综合指标之一。本文回顾性分析了皮山县2004—2008年我县孕产妇死亡情况，通过孕产妇死亡评审，找出影响孕产妇死亡率的重要原因，提出针对性的干预措施，以降低孕产妇死亡率。     

昭通市6个贫困县孕产妇死亡情况分析

目的分析造成孕产妇死亡的主要原因和相关因素,有针对性的提出降低孕妇死亡率的干预措施.方法按全国孕产妇死亡监测方案,通过逐级收集、评审后,总结分析孕产妇主要死亡原因及相关因素.结果孕产妇死亡的前三位死因依次为产后出血、妊高征、产后感染.经济贫困、孕产期保健、妇幼卫生服务能力、群众自我保健意识是影响孕产妇死亡的主要因素.结论应加强村级接生员及防保员职能转换;加强基层产科建设;提高产科医护人员专业技术水平;加大健康教育力度.     

2006—2010年普兰店市孕产妇死亡情况及相关因素分析

目的探讨该市孕产妇死亡情况,制定减少孕产妇死亡的干预措施,有效降低本市孕产妇死亡率。方法对2006—2010年普兰店市孕产妇死亡监测及评审资料进行分析。结果 5年间孕产妇死亡率总体来看呈下降趋势,但第5年又有所上升,有一定的波动性。孕产妇死亡原因构成:主要是直接产科死亡原因,占55.6%,羊水栓塞和异位妊娠居首位,均占22.2%。评审结果:主要是创造条件可以避免死亡占50%。结论充分发挥危重孕产妇抢救专家组的作用,加强对全市助产技术人员的业务培训,加强对高危妊娠的管理,做好转诊追访工作是降低孕产妇死亡率的关键。     

四平市孕产妇死亡情况分析及干预措施

目的：探讨孕产妇死亡的原因,采取行之有效的措施,以降低孕产妇死亡率。方法：按照吉林省统一的孕产妇死亡监测方案要求,开展孕产妇死亡监测工作。结论：2006年10月1日～2007年9月31日间孕产妇死亡率42．34／10万,死因顺位第1位是妊娠期高血压疾病,第2位是妊娠期合并心脏病,产后出血、羊水栓塞、乙型肝炎、肺静脉栓塞及切口裂开出血并列第3位。评审结果：可避免死亡占53．85％,不可避免占46．15％。干预措施：①加大健康宣教力度,提高群众自我保健意识;②加强产科培训力度,提高诊治水平;③加强基层网络建设,使孕产妇高危管理工作做到位。     

抚顺市1996～2005年孕产妇死亡状况分析

目的 分析抚顺市孕产妇死亡原因及死亡孕产妇接受保健情况,提出干预措施.方法 回顾分析1996～2005年抚顺市孕产妇死亡监测数据.结果 10年间全市孕产妇死亡率呈下降趋势,自2002年后下降速度明显减慢.近两年又有反弹.结论 通过分析孕产妇死亡率变化趋势及下降速度的影响因素,包括医疗保健系统资源不足、医疗保健系统知识技能不足、孕产妇系统管理不到位、贫困孕产妇得不到救助等多方面原因,提出干预措施,有效降低抚顺市孕产妇死亡率.     

孕产妇死亡情况调查分析

目的分析孕产妇死亡原因,提出改进意见,制定可行性的干预措施,以降低死亡率。方法对二七区1998-2010年孕产妇死亡的资料进行回顾性分析。结果二七区孕产妇死亡共23例,其中产科出血9例,占死亡的39．13％,位居第1位;内科合并症7例,占死亡的30．43％,居第2位;妊娠高血压综合症3例,占死亡的13．04％,排第3位;羊水栓塞1例,占死亡的4．34％,居第4位。结论加强高危孕产妇的系统管理率、提高农村的住院分娩率、加强计划外及流动人口孕产妇管理率是降低孕产妇死亡率的关键。     

2015-2016年四川省孕产妇死亡评审情况分析

目的 通过对2015-2016年四川省孕产妇死亡评审情况进行分析,以期为卫生计生行政部门、医疗保健机构采取措施减少孕产妇死亡,进一步降低孕产妇死亡率提供参考.方法 死亡评审专家组依据WHO的“十二格法”对四川省2015-2016年163例孕产妇死亡资料进行评审,本研究对评审结果进行描述性分析.结果 省级已完成163例孕产妇死亡评审,产科出血、妊娠期高血压疾病、静脉血栓形成及肺栓塞症、心脏病、羊水栓塞是四川省孕产妇死亡的前5位主要原因.163例已评审的死亡病例中,可避免死亡124例,占76.07％,不可避免死亡39例,占23.93％.124例可避免死亡病案中,按首位影响因素分析,医务人员知识技能因素67例,占54.03％,居第1位,其中县、乡级医务人员知识技能因素分别占37.90％和5.65％;个人家庭因素57例,占45.97％.结论 加强高危孕妇规范化管理工作,保障边远地区血源供应及时,加强产科医务人员急救知识培训成为四川省减少孕产妇死亡的重要措施.     

三台县62例孕产妇死亡原因分析

目的 通过对孕产妇死亡原因的分析,为降低孕产妇死亡率提出干预措施.方法 对1997～2006年共10年的孕产妇死亡资料进行分析.结果 前三位的死亡原因是:产科出血,妊高征,羊水栓塞;Ⅰ类可避免死亡22.58%;Ⅱ类创造条件可避免的死亡56.45%;Ⅲ类不可避免的死亡20.97%.结论 政府加大投入,实施"降消"项目,新农合的开展,各部门配合,卫生系统提高自身服务能力,健康教育是降低孕产妇死亡率的有效措施.     

Perinatal mortality at the Port Moresby General Hospital and St. Therese's Maternity Hospital 1972

A study was made of the 67 still-births and the 58 neonatal deaths that occurred among the 3,516 viable infants (birth weight 1,000 g. or more) that were born to public patients of the obstetric units of Port Moresby General Hospital and St. Therese's Maternity Hospital during the year 1972. The combined stillbirth and neonatal mortality rate was 35.5 per 1,000 births. The adverse effects of lack of antenatal care, delivery outside hospital, high parity, maternal anaemia, mulitple pregnancy, and low birth weight are demonstrated. Low birth weight (1,000 to 2,200 g.) of unknown cause accounted for 24.0 per cent of the deaths. In 16,8 per cent of cases the birth weight was more than 2,200 g. and the cause of death was unknown. Birth trauma accounted for 19.2 per cent of the deaths, congenital malformation for 11.2 per cent, antepartum haemorrhage for 11.2 per cent, toxaemia for 10.4 per cent, and maternal disease for 3.2 per cent. There were miscellaneous causes in 4.0 per cent of cases. Approximately 75 per cent of the deaths were considered to be the result of unfavourable factors in the mother's environment. Approximately 14 per cent were primarily the result of obstetric complications and might have been avoided by a higher standard of obstetric care. Improving the standard of obstetric care that is presently available in Port Moresby would probably reduce the perinatal mortality rate by not more than 5 per 1,000.     

Maternal mortality in Papua New Guinea 1971 and 1972

Reports were received on 364 of the unknown number of maternal deaths that occurred in Papua New Guinea during the two years, 1 January, 1971 to 31 December, 1972. Postpartum haemorrhage accounted for 39 per cent of the deaths, puerperal sepsis for 19 per cent and associated conditions for 14 per cent. In 13 per cent of cases the cause of death could not be ascertained. Obstructed labour caused 4 per cent of the deaths, ruptured uterus 4 per cent, antepartum haemorrhage 3 per cent and abortion 3 per cent. Three deaths were due to miscellanous causes. It is possible that three of the deaths (0.8 per cent of the total) in the cause unascertained group were due to toxaemia of pregnancy. In the coastal districts the major cause of death was postpartum haemorrhage (53 per cent) and the major high-risk factor was grand multiparity (5 or more). In the highlands the major cause of death was puerperal sepsis (41 per cent) and the major high-risk factor was nulliparity. About 50 per cent of all pregnant women in Papua New Guinea are seen at antenatal clinic and about 25 per cent of all births occur in hospital or heath centre. Forty-four per cent of the women who died (abortion excluded) were seen at antenatal clinic and 18 per cent were delivered in hospital or health centre. High-risk factors were present in 87 per cent of women who were seen at antenatal clinic, but only 28 per cent of these high-risk women were delivered in hospital or health centre. Extension of the antenatal services will not result in a major reduction in maternal mortality unless high-risk factors are recognised and unless high-risk mothers can be persuaded to have their babies in hospital or health centre.     

Effect of medical thromboprophylaxis on mortality from pulmonary embolus and major bleedingy

Background

Several studies have failed to discover a beneficial effect of medical thromboprophylaxis on mortality.

Aims

To examine the relative influence of acute fatal pulmonary embolism (PE) and fatal major haemorrhage on overall mortality in medical patients treated with low molecular weight heparin (LMWP) for prophylaxis.

Methods

The author compared deaths from the above factors using data from a recent Cochrane Collaboration meta-analysis. Data from trials satisfying the criteria of the Cochrane analysis plus additional exclusions to avoid bias were pooled to produce point estimates of mortality from PE and major bleeds to estimate net mortality benefit. Estimates were then subject to limited sensitivity analysis based on reported epidemiological data.

Results

Reported PE and major bleeds were 0.44 per cent and 0.27 per cent, respectively. The corresponding case-specific mortality rates were 30.8 per cent and 12.8 per cent and the relative risk reduction (RRR) for PE was 23.2 per cent. Estimated deaths from major bleeds exceeded PE deaths avoided by a small margin (3/100,000 patients given prophylaxis). This excess increased to 30/100,000 when more plausible literature values for PE case fatality rates were applied.

Conclusion

Medical thromboprophylaxis has a finely balanced effect on mortality but may increase it. Such an effect would explain the failure to discover a mortality benefit from medical thromboprophylaxis. Further work, including a formal meta-analysis and additional clinical studies, is required to confirm this picture.     

Maternal and Perinatal Mortality Associated with Cesarean Section in Alberta (1955-1959)

A province-wide study of perinatal mortality was initiated in Alberta (population 1,283,000) in 1955. The period 1955-1959 covered 182,028 total births and 4219 perinatal deaths of which 260 were from 3813 Cesarean sections.

The perinatal mortality rate in Cesarean-section births in rural hospitals (101.4 per thousand Cesarean births) was compared with that for urban hospitals (55.7 per thousand).

Examination of the indications for primary Cesarean section in which a perinatal death occurred showed that hemorrhage accounted for 54 out of 85 of these deaths in rural hospitals, and 49 out of 110 similar urban deaths. Of 33 perinatal deaths associated with elective repeat sections, 17 were of premature babies.

Eleven of the 85 maternal deaths during 1955-1959 were associated with Cesarean section, a maternal mortality rate of 28.8 per 10,000 Cesarean section births. Preventable factors were present in 8 of the 11 cases. Hemorrhage was the primary cause of death.

     

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.     

Strategies for reduction of neonatal mortality

Summary  Infant mortality rates in developed countries have shown significant decreases in recent years. Two-thirds of infant mortality still occurs in the neonatal period and our aim in this study was to review the causes of these neonatal deaths and see where further improvements may be possible. A 6-yr review of all neonatal deaths of live-born infants over 500g birthweight from 1991 to 1996 was made. The 1989 amended Wigglesworth classification was used to categorise cause of death and other perinatal variables were also recorded. Results show there were 34,375 births and 153 neonatal deaths. Classification of these deaths by Wigglesworth found 78 (51 per cent) due to congenital malformations, 58 (38 per cent) due to prematurity, 6 (4 per cent) due to asphyxia and 11 (7 per cent) due to specific other causes. The corrected neonatal mortality was 2.18. Neural tube defects alone accounted for 10 per cent of the total neonatal mortality. Fifty-five out of 58 infants who died due to prematurity had birthweight < 1000g and survival rates in this group compared well to international standards. We conclude that a reduction in neonatal mortality is possible but is most likely to result from community focused measures such as increased use of pre- and peri-conceptional folate.     

INCREASING CAESAREAN SECTION AND PERINATAL OUTCOME

An analysis of births by caesarean sections for ten years at a service hospital was carried out to identify the benefit in terms of reduction in perinatal mortality over the period without increase in maternal mortality and morbidity. An increase of 43.25 per cent in caesarean section rate was observed. Since 1986 there had been no significant change in the indications for caesarean sections or obstetrical care in terms of man and machine modernisation at this hospital. New born''s care in this hospital is supervised by obstetrician and medical specialist. However, a definite reduction in perinatal mortality rate by 59.68 per cent was noted with no maternal mortality in caesarean cases. This retrospective study showed that the judicious increase of caesarean sections could improve perinatal outcome.KEY WORDS: Perinatal mortality in caesarean section, Perinatal outcome with increased caesarean section rate     

承德县1996-2006年孕产妇死亡情况调查分析

目的通过对承德县孕产妇死亡原因的分析,理解其死亡原因,找出孕产期保健及产科处理上的薄弱环节和存在的问题,提出改进措施,为制定有效干预措施减少孕产妇死亡提供科学依据。方法收集1996-2006年承德县妇幼卫生统计报表,采用描述统计学方法进行分析。结果承德县平均孕产妇死亡率为59.47/10万,前四位死因是产科出血、妊娠内科合并症、羊水栓塞、妊高症。结论通过对三级妇幼及临床人员的培训和进修,提高基层妇幼保健及妇产科专业技术人员综合素质,加强产科质量建设,完善产科设备,加大健康教育的宣传力度,孕产妇死亡率得到明显下降。     

Causes of maternal mortality in Japan

CONTEXT: Japan's maternal mortality rate is higher than that of other developed countries. OBJECTIVES: To identify causes of maternal mortality in Japan, examine attributes of treating facilities associated with maternal mortality, and assess the preventability of such deaths. DESIGN AND SETTING: Cross-sectional study of maternal deaths occurring in Japan between January 1, 1991, and December 31, 1992. SUBJECTS: Of 230 women who died while pregnant or within 42 days of being pregnant, 197 died in a hospital and had medical records available, 22 died outside of a medical facility, and 11 did not have records available. MAIN OUTCOME MEASURES: Maternal mortality rates per 100,000 live births by cause (identified by death certificate review and information from treating physicians or coroners); resources and staffing patterns of facilities where deaths occurred; and preventability of death, as determined by a 42-member panel of medical specialists. RESULTS: Overall maternal mortality was 9.5 per 100,000 births. Hemorrhage was the most common cause of death, occurring in 86 (39%) of 219 women. Seventy-two (37%) of 197 deaths occurring in facilities were deemed preventable and another 32 (16%) possibly preventable. Among deaths that occurred in a medical facility with an obstetrician on duty, the highest rate of preventable deaths (4.09/100,000 live births) occurred in facilities with 1 obstetrician. Among the 72 preventable deaths, 49 were attributed to 1 physician functioning as the obstetrician and anesthetist. While the unpreventable maternal death rate was highest in referral facilities, the preventable maternal death rate was 14 times lower in referral facilities than in transferring facilities. CONCLUSIONS: Inadequate obstetric services are associated with maternal mortality in Japan. Reducing single-obstetrician only delivery patterns and establishing regional 24-hour inpatient obstetrics facilities for high-risk cases may reduce maternal mortality in Japan. JAMA. 2000;283:2661-2667.     

International Maternal Mortality Reduction: Outcome of Traditional Birth Attendant Education and Intervention in Angola

Background. As a result of war and periodic natural disasters, Angola has among the highest infant and maternal mortality rates in the world. In response to the acute health needs of the population, the International Medical Corps (IMC) developed a traditional birth attendant educational course designed to reduce the preventable causes of maternal and infant mortality. Methods. From 1994 until 1998, Angolan traditional birth attendants (TBAs) participated in an intensive 38-hr training course on prenatal, delivery, and postnatal care. Following the birth of a child, the trained TBAs completed a registration form containing information regarding the health of the mother. Previous studies of Angolan maternal mortality served as historic comparisons. Findings. Complete data including maternal mortality data were available for 19,666 deliveries (83% of total). Fifty five maternal deaths were recorded, which corresponds to a maternal mortality rate of 293 per 100,000 live births. The average historic maternal mortality rate for available comparison groups was 1241 per 100,000 live births. Interpretation. The maternal mortality rate was reduced among women managed by IMC-trained TBAs when compared with historical control data.