上海市孕产妇死亡监测资料初步分析

[目的]　分析本市1989～1998年孕产妇死亡变化和原因,总结围产保健管理经验并讨论有待突破的若干环节。[方法]　根据死亡监测网络上报,市妇保所质量管理科调查和专家组评审的资料统计分析。[结果]　本地孕妇分娩活产数持续下降,近10年减少了38%,孕产妇死亡率波动在11.47/10万～29.60/10万,总体上趋于稳中有降,产后出血是首位原因;外来孕妇分娩活产数不断上升,近10年增加了3.43倍,孕产妇死亡率波动在29.08/10万～109.61/10万,多年居高不下,产科出血和产科感染是主要死因。[结论]　在降低孕产妇死亡率方面取得了一定成绩。人才培养,业务管理和执法力度等方面仍待进一步加强。     

男性主动参与围产保健重要性的临床探讨

目的:探讨男性主动参与围产保健的重要性。方法:丈夫主动参与围产保健的109例初产妇为研究组,同期无丈夫参与围产保健的116例初产妇为对照组,将两组孕妇进行对照分析。结果:研究组产前检查次数明显多于对照组(P<0.01),妊娠并发症的发生率明显低于对照组(P<0.05),分娩时的忧郁和恐惧、对阴道分娩缺乏信心、惧怕分娩的疼痛、担心分娩中发生难产等心理状态的发生率均明显低于对照组(P<0.01),阴道自然分娩率高于对照组(P<0.05),剖宫产率低于对照组(P<0.05)。结论:男性主动参与围产保健可以提高围产保健质量,促进自然分娩,降低剖宫产率,值得临床推广。     

家庭关怀对孕妇焦虑和抑郁的影响研究

孕妇心理保健已成为围产保健中一个不可忽视的部分,越来越受到人们的普遍关注。分娩虽是生理过程,但分娩对于孕妇来说确实是一种持久而强烈的应激源,怀孕和分娩使妇女角色发生转换呈现为一种心理压力状态,对孕妇个体会带来重大的生理和心理上的应激反应。良好的社会支持可以大大缓解人们的心理压力,促进人们的身心健康,良好的家庭关怀同样对焦虑和抑郁的患者起着积极的作用。近年来,少数学者开始关注家庭功能和家庭关怀对孕产妇的心     

孕产期保健和心理护理对分娩过程的影响分析

妊娠和分娩是一个特殊的生理过程,是围产保健最重要最关键的阶段[1].孕产期保健和心理护理的目的主要是通过产前检查、健康监测、宣传教育和咨询服务等措施保证妊娠过程正常进展,维护孕产妇身心健康和胎儿正常的生长发育,尽快发现异常,尽早筛查出妊娠期可能发生的并发症并及时处理,预防其严重并发症的发生;同时处理一些因妊娠加重的疾病,防止对孕妇、婴儿有不良影响的疾病.     

心理疗法配合无痛分娩仪用于分娩镇痛效果观察

分娩是一个特殊的生理过程,是围产保健工作中极其重要的环节。初产妇由于没有经验,90％以上对分娩过程存在着紧张、焦虑、恐惧,其引起的心理应激对母婴均会产生不良的后果。为了提高自然分娩率,降低剖宫产率,缩短产程,减轻产妇的痛苦,保障母婴的安全,我院2005—2006年对部分住院孕妇实施心理疗法配合无痛分娩仪进行分娩镇痛,取得了满意的效果,现报告如下。     

产后抑郁症及社区干预

随着围产医学的发展,孕产妇的心理保健已成为围产保健中一个不可忽视的部分,妊娠虽然是发育年龄妇女一种正常、自然的生理现象,但对孕产妇来说,毕竟是一次巨大的生理变化和心理应激过程,她们在经历怀孕、分娩、产后恢复及哺乳等一系列生理过程中,会产生各种心理、生理变化,一旦某些改变的程度和性质超越了正常的变异界限,则成为病理性改变.     

孕妇心理状况及其对分娩结局的影响

目的 了解孕妇产前心理因素对分娩结局有无影响,为进一步提出孕产妇心理干预措施提供理论依据.方法 整群抽样方法抽取孕妇,控制影响分娩结局的主要生理、病理因素后进行SCL-90项调查和分娩结局调查.资料采用Foxpro建立数据库后采用t检验分析.结果 孕妇心理状况对孕妇最终的分娩结局具有重要影响.结论 做好孕妇心理保健对于提高分娩质量,降低难产、产后出血和新生儿窒息发生率具有重要意义.     

产前健康教育及孕期保健操对分娩过程影响的研究进展

<正>随着社会进步、经济发展以及医学模式的转变,人们对健康保健的需求越来越高。围生期对妇女来说,是一个特殊的生理时期。虽然妊娠和分娩是一个正常的生理过程,但对孕妇的生理和心理都会产生很大的应激。进行孕期保健及产前健康教育,可以帮助孕妇顺利渡过围生期,在生理、心理、精神上提供支持,降低剖宫产率及围生期并发症发生率。孕期保健     

产后抑郁症的健康教育

随着围产医学的发展，孕产妇的心理保健已经成为围产保健中一个不可忽视的部分，妊娠虽然是发育年龄妇女一种正常、自然的生理现象，但对孕产妇来说，毕竟是一次巨大的生理变化和心理应激过程，她们在经历怀孕、分娩、产后恢复及哺乳等一系列生理过程中，会产生各种心理、生理变化，一旦某些改变的程度和性质超越了正常的变异界限，则成为病理性改变。因此，对孕产妇及其家属进行健康教育是非常必要的。     

孕妇接受围产期保健教育的作用观察

目的探讨孕妇学校在围产期保健中的作用.方法对我院2006年1～12月接受孕妇学校围产期保健的100例孕妇进行观察,同时选择100例未接受孕妇学校围产期保健孕妇为对照.结果观察组,孕妇对异常情况识别占60%,产妇分娩时心理状态安全感占96%,产后出血占9.0%,新生儿Apgar评分＜7分的占2.0%;对照组,孕妇对异常情况识别占16%,产妇分娩时心理状态安全感占71%,产后出血占18%,新生儿Apgar评分＜7分的占5.0%.两组比较有显著性差异(P＜0.05).结论孕妇开展的国产期知识教育,具有识别异常情况,引起孕妇警觉尽早就医,减轻心理负担、消除恐惧、缩短产程、减少产后出血等优点,值得我们在临床上大力推广.     

九江市农村育龄妇女孕产期保健服务需求状况分析

目的:了解九江市农村育龄妇女孕产期保健服务需求的现状,探讨农村育龄妇女孕产期保健服务需求的差异。方法:采用分层-整群抽样方法随机抽取九江市3476例农村育龄妇女作为调查对象进行结构式访谈问卷调查。结果:农村育龄妇女普遍存在孕产期保健意识缺乏现象,孕期保健和住院分娩地点主要选择县、乡两级,农村育龄妇女孕期保健的目的主要是为了了解胎儿的发育情况;半数以上不愿意接受医生指导的孕期常规筛查项目,调查对象认为"没必要"筛查;尚有17.3%的农村育龄妇女在停经4个月后才进行初次产检;1.4%的农村育龄妇女选择家庭、村级卫生所为分娩地点。结论:建议给予县、乡两级孕产期保健服务能力建设以持续和重点支持。建议采用进村入户发放传单、张贴标语、讲解典型事例、与家庭成员商谈等更深入细致的健康教育形式,消除农村育龄期妇女孕产期保健知识的盲点。     

Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics

PURPOSE: To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC). DATA: Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province. FINDINGS: 54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care. CONCLUSIONS: Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.     

围产期保健卡在围产期保健管理中的应用

介绍南昌市卫生保健机构为已怀孕者及已孕流动人口建围产期保健卡,并通过围产期保健卡记录的诊疗信息对孕产妇的危险性进行评估,及时筛查高危孕产妇,并加强对孕产妇的系统管理.同时探讨在以后的工作中,应进一步加强规范化、信息化孕产妇围产期管理,争取建立妇幼保健数据库,提高围产期保健服务能力.     

2002年项目地区42个贫困县妇女保健现况分析

目的 :对项目县妇女分娩前后所接受的卫生服务调查、分析影响住院分娩的因素 ,评价农村初级卫生保健项目的执行情况和效果 ,并提出促进母亲安全分娩的有效措施。方法 :采用分层多阶段随机抽样法获取样本。结果 :产前检查率均在 97.1%以上 ,产前检查地点主要以乡卫生院为主占 53 .1% ,住院分娩率逐年在提高 ,住院分娩地点仍以乡卫生院为主占 40 .6% ,但仍有少数孕妇在家分娩。结论 :由于我国西部 42个项目县的大部分地区较为贫困 ,交通不便等问题 ,仍有一些孕妇在家分娩 ,村接生员仍是主要的接生者。怎样提高住院分娩率 ,保障母亲婴儿健康 ,提高出生人口素质 ,还需加强宣传力度 ,以此来促进贫困地区妇女儿童健康     

广州市荔湾区产妇心理卫生服务利用现状调查

目的:调查产妇心理状况及其对心理卫生保健服务的利用现状,为探索在社区开展产妇心理卫生服务的模式提供依据。方法:在广州市荔湾区随机抽取5所社区卫生服务中心,对各中心产妇心理卫生服务状况进行调查,随机抽取产后42天产妇进行产后抑郁、心理卫生服务问卷调查。结果:产妇抑郁阳性率34.5%。27.6%产妇曾有心理卫生服务需要,16.3%曾接受过某种形式心理卫生服务。产妇对心理卫生服务的主观需求与产妇的心理健康状况、职业、家庭经济状况、费用支付方式、生育准备、是否上孕妇学校有关。结论:产妇存在着较大的心理问题,但针对产妇的心理卫生服务缺乏,为了增加产妇对心理卫生服务的主动性,社区卫生保健工作者应考虑服务的价格因素,加大心理卫生知识的宣传力度,将心理医生整合到初级保健机构,实现初级保健和心理关怀的融合。     

Maternal health during pregnancy and perinatal mortality in Bangladesh: evidence from a large-scale community-based clinical trial

Perinatal mortality is very high in Bangladesh. In this setting, few community-level studies have assessed the influence of underlying maternal health factors on perinatal outcomes. We used the data from a community-based clinical controlled trial conducted between 1994 and 1997 in the catchment areas of a large MCH/FP hospital located in Mirpur, a suburban area of Dhaka in Bangladesh, to investigate the levels of perinatal mortality and its associated maternal health factors during pregnancy. A total of 2007 women were followed after recruitment up to delivery, maternal death, or until they dropped out of the study. Of these, 1584 who gave birth formed our study subjects. The stillbirth rate was 39.1 per 1000 births [95% confidence interval (CI) 39.0, 39.3] and the perinatal mortality rate (up to 3 days) was 54.3 per 1000 births [95% CI 54.0, 54.6] among the study population. In the fully adjusted logistic regression model, the risk of perinatal mortality was as high as 2.7 times [95% CI 1.5, 4.9] more likely for women with hypertensive disorders, 5.0 times [95% CI 2.3, 10.8] as high for women who had antepartum haemorrhage and 2.6 times [95% CI 1.2, 5.8] as high for women who had higher haemoglobin levels in pregnancy when compared with their counterparts. The inclusion of potential confounding variables such as poor obstetric history, sociodemographic characteristics and preterm delivery influenced only marginally the net effect of important maternal health factors associated with perinatal mortality. Perinatal mortality in the study setting was significantly associated with poor maternal health conditions during pregnancy. The results of this study point towards the urgent need for monitoring complications in high-risk pregnancies, calling for the specific components of the safe motherhood programme interventions that are designed to manage these complications of pregnancy.     

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15-49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings.     

湖南省妇幼保健机构产后抑郁症防治现状及需求研究

目的通过对全省妇幼保健机构的抽样调查,了解产后抑郁症的防治能力和需求状况,为下一步有针对性地指产后抑郁症防治的开展,制定适合三级妇幼保健网络的孕产期心理保健方案奠定基础。方法采取多阶层随机整体取样的方法抽取湖南省16家妇幼保健机构和179位医务人员。结果在16所调查的妇幼保健机构中,开展了产后抑郁症筛查的机构7所,占43.8%,开展了心理咨询门诊的4所,占25.0%,配备了心理疏导、心理治疗设施设备的2所,占12.5%。179名被调查的医务人员中,有68.7%的认为所在机构对产后抑郁症的防治不能满足孕产妇的需求。结论全省妇幼保健机构对产后抑郁症的识别和干预机制不健全,网络覆盖不全面,医务人员的服务能力不强,下一步应逐步完善防治网络和强化能力建设。     

中国农村已婚妇女社会性别意识、家庭事务决策及孕产期保健状况调查

目的了解中国农村地区已婚妇女对社会性别平等的认识、家庭决策权状况及其对孕产期保健服务利用的影响。方法2004年11-12月在河北、湖北和四川省的3个联合国人口基金项目县,对1227名有0～7岁孩子的妇女进行面对面问卷调查。调查对象采用多阶段整群抽样方法获得。结果65．1％的妇女社会性别平等的认识情况较差或一般,593％的妇女认为“丈夫的健康比妻子更重要”,39.7％的妇女同意“男人比女人更适合做领导”。46．2％的家庭是夫妻共同当家,16．2％是妇女自己当家。67.1％的妇女在平时花钱买东西时需要征得丈夫同意。当夫妻间意见不一致时,20．5％的妇女回答总是按照丈夫的意见来办理,17．4％的妇女大多数情况下按照自己的意见来处理。总的来讲,64．1％的调查对象家庭决策权较小或属于中等水平。91.0％的妇女存孕期做过产前检查;在做过产前检查的妇女中,65．3％的妇女在孕早期进行了第一次产前检查,39．7％的妇女接受了5次及以上产前检查。妇女住院分娩率是59．3％。妇女对社会性别平等的认识情况、对妇女的产前检查服务利用情况没有明显作用,但影响妇女的住院分娩。文化程度是影响妇女孕产期保健服务利用的重要因素,对产前检查服务的利用和住院分娩都有显著作用。结论应提高农村妇女的社会性别平等意识和家庭地位,改善孕产期保健服务利用情况。     

Characterization of U.S. State Laws Requiring Health Care Provider Reporting of Perinatal Substance Use

BackgroundState policies pertaining to health care provider reporting of perinatal substance use have implications for provider screening and referral behavior, patients’ care seeking and access to prenatal substance use disorder treatment, and pregnancy and birth outcomes.ObjectivesThis study sought to characterize specific provisions enacted in state statutes pertaining to mandates that health care providers report perinatal substance use, and to determine the proportion of births occurring in states with such laws.MethodsWe conducted a systematic content analysis of statutes in all U.S. states that mentioned reporting by health care providers of substance use by pregnant women or infants exposed to substances in utero; inter-rater reliability was high. We calculated the number of states, and proportion of U.S. births occurring in states, with processes for mandatory reporting of perinatal substance use to authorities, and substance use disorder treatment provision for individuals who are reported.ResultsTwenty states (corresponding with 31% of births) had laws requiring health care providers to report perinatal substance use to child protective authorities, and four states (18% of births) had laws requiring reporting only when a health care provider believed the substance use was associated with child maltreatment. About one-half of states (13) with any reporting law had a provision promoting substance use disorder treatment in the perinatal period.ConclusionsFindings inform the ongoing debate about how health policies may be used to reduce the population burden of perinatal substance use.