120例围产儿死亡分析

目的分析120例围产儿死亡原因,以改进围产期保健,提高产科质量。方法对我院1998年1月-2007年12月间围产儿死亡病例进行回顾性分析。结果期间围产儿总数为10861例,其中死亡120例,死亡率为11．05％。死亡120例中本院常规检查占46．7％（56／120）,无常规围产保健或外院检查异常转入我院占53．3％（64／120）,死胎48．3％（58／120）,死产13．3％（16／120）,新生儿死亡38．3％（46／120）;早产92例（76．7％）,足月产28例（23．3％）,先天畸形24．2％（29／120）,另有22例体重大于1500g的无畸形新生儿死亡。结论早产、先天畸形、体重过大是围产儿死亡的主要原因;加强流动人口孕产妇的孕期保健,积极进行产前诊断是减少围产儿死亡的重要途径。     

北京市东城区2002—2006年围产儿死亡原因分析

目的分析流动人口围产儿死亡原因,为制定流动人口孕产妇保健管理模式提供依据。方法采用回顾性调查方法,取东城区2002-2006年围产儿死亡病例及评审资料进行分析,对东城区户籍人口与流动人口孕产妇孕期保健及围产儿死亡情况进行比较。结果该期间东城区户籍围产儿死亡率5.54‰,流动人口围产儿死亡率21.57‰。东城区户籍围产儿死因顺位依次为胎儿畸形、原因不明、胎盘脐带因素、胎儿因素、母亲因素、新生儿疾病。流动人口围产儿死因顺位依次为胎儿畸形、胎儿因素、母体因素、胎盘脐带因素、新生儿疾病。胎儿畸形为第一位死因。流动人口围产儿死亡中孕妇未进行孕期正规产检占65.77%,东城户籍围产儿死亡中孕妇未进行孕期正规产检占16.39%。结论东城区辖区医院5年来围产儿死亡呈下降趋势;流动人口围产儿死亡率下降不明显,而且明显高于东城区户籍人口围产儿死亡率。流动人口孕妇孕期保健覆盖率低。制定相应措施,加强流动人口孕期保健管理和健康宣教,提高孕妇的自我监测能力,向贫困流动人口孕妇提供基本的免费孕期保健服务,是降低围产儿死亡的有效措施。     

Perinatal mortality rate in a south Indian population

Perinatal mortality rate was assessed for 13964 consecutive births in SAT Hospital, Trivandrum, South India, during a period of one year. The overall perinatal mortality rate was 42.75, stillbirth rate 24.41 and early neonatal mortality rate 18.79. The perinatal mortality rate in multiple pregnancy was 156.65. Preventable causes of perinatal mortality still make a major contribution to perinatal deaths in developing countries.     

71例围产儿死亡原因分析

目的：分析围产儿死亡原因,以提高围产期保健质量,降低围产儿死亡率。方法：按照围产期Ⅰ标准,对我院1992～2001年间71例住院围产儿死亡病例进行回顾性分析。结果：围产儿死亡率为11．10%,死亡原因排在前3位的是：脐带因素、畸形和早产,占同期围产儿死亡原因的49．29％;流动人口围产儿死亡率明显高于常住人口。结论：加强区域围产期保健网的作用,加强对流动人口的管理,及时发现并治疗高危妊娠是降低围产儿死亡的主要措施。     

236例围生儿死亡相关因素分析

目的了解住院分娩围生儿死亡情况,探讨引起围生儿死亡的相关因素。方法回顾性分析8836例围生儿的临床资料,对其中妊娠满28周至产后7d内死亡的围生儿逐一进行分类和统计学分析。结果围生儿死亡236例,病死率为26.71‰;男围生儿病死率(22.88‰)显著低于女围生儿病死率(30.63‰);农村围生儿病死率(41.79‰)显著高于城市围生儿病死率(4.97‰);初中及以下文化的产妇其围生儿病死率(28.38‰)显著高于高中及以上者(12.71‰);出生体质量<2500g的围生儿其病死率(134.88‰)显著高于出生体质量≥2500g者(13.69‰),差异均有统计学意义(P<0.05)。围生儿死亡构成中死胎占71.19%,死产占17.79%,早期新生儿死亡占11.02%。围生儿前5位死因顺位是胎儿畸形89例(37.71%)、不明原因77例(32.63%)、宫内窘迫15例(6.36%)、脐带因素14例(5.93%)、胎盘因素12例(5.08%)。结论本地区围生儿病死率高,农村、低出生体质量者及产妇文化程度低者为甚;预防围生儿死亡形势严峻,重点在农村,主要干预措施是提高农村人口文化素质,加强婚前检查、围生期保健、产前筛查,预防畸形儿进入围生期,预防早产。     

Proportionate mortality trends: 1950 through 1986

Mortality trends in the United States from 1950 through 1986 were analyzed for the conditions that are or have recently been among the six leading causes of death. The age-adjusted mortality rate for all causes has decreased from 841.5 to 541.7 per 100,000 population. Cause-specific, age-adjusted mortality rates have declined from 1950 through 1986 for cerebrovascular disease, injuries, perinatal conditions, heart disease, and influenza and pneumonia. Time trends in the proportion of persons dying of each of these diseases, however, have varied; the proportion dying of cerebrovascular disease, injuries, and perinatal conditions has decreased, and the proportion of persons dying of heart disease and influenza and pneumonia has remained fairly stable from 1950 through 1986. During this same time, age-adjusted death rates have increased for chronic obstructive pulmonary disease and have remained fairly stable for malignant neoplasms, while the proportions of persons dying of chronic obstructive pulmonary disease and malignant neoplasms have increased dramatically. For people aged 35 to 64 years, malignant neoplasms have now overtaken heart disease as the leading cause of death. For those aged 65 years and older, heart disease remains the leading cause of death, accounting for almost 50% of all deaths in persons 85 years and older.     

剖宫产率及指征变化与新生儿窒息、围生儿死亡率的关系

目的 探讨剖宫产率及指征变化与新生儿窒息、围产儿死亡率关系。方法 对我院近10年产科分娩病例进行回顾性分析,了解其剖宫产率,剖宫产指征及新生儿窒息、围生儿死亡率。结果 1993-1997年(A组)剖宫产率25.77％,而1998-2002年(B组)剖宫产率48.62％,B组明显高于A组(P<0.01)。在剖宫产指征中,社会因素剖宫产从A组第6位升到B组第2位,从5.83％上升到26.30％,而难产、胎儿窘迫及疤痕子宫指征相对下降。两组新生儿窒息、围生儿死亡率比较无明显差异(P>0.05)结论 社会因素是剖宫产率升高的重要原因;随着剖宫产率的进一步上升,围生儿的病死率并未相应降低;必须正确掌握剖宫产指征,普及产科知识,降低剖宫产率及新生儿窒息、围生儿死亡率。     

Impact of increased rate of caesarean section on perinatal outcome: sociolegal evaluation

Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.     

剖宫产率及指征变迁分析

目的 :探讨剖宫产率增高的因素及指征的变迁。方法 :对 8年来 4148例剖宫产病例进行回顾性研究分析。结果 :剖宫产率前 5年随年份增加而显著增高 (P <0 .0 5 ) ,后 3年增高不明显 (P >0 .0 5 ) ;剖宫产指征中胎儿因素增加不明显 (P >0 .0 5 ) ,但仍居首位 ,母亲因素及社会因素增加显著 (P <0 .0 5 ) ;围生儿死亡率下降 1.19倍。结论 :剖宫产率升高在一定程度上降低了围生儿死亡率。但围生儿死亡率的进一步降低需依靠整个围生医学的发展。     

Two year audit of perinatal mortality at Kathmandu Medical College Teaching Hospital.

Introduction: Perinatal mortality rate is a sensitive indicator of quality of care provided to women in pregnancy, at and after child birth and to the newborns in the first week of life. Regular perinatal audit would help in identifying all the factors that play a role in causing perinatal deaths and thus help in appropriate interventions to reduce avoidable perinatal deaths. Aims and objectives: This study was carried out to determine perinatal mortality rate (PMR) and the factors responsible for perinatal deaths at KMCTH in the two year period from November 2003 to October 2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the still births and early neonatal deaths in KMCTH during the two year period from November 2003 to October 2005. Details of each perinatal death were filled in the standard perinatal death audit forms of the Department of Pediatrics, KMCTH. Perinatal deaths were analyzed according to maternal characteristics like maternal age, parity, type of delivery and fetal characteristics like sex, birth weight and gestational age and classify neonatal deaths according to Wigglesworth's classification and comparison made with earlier similar study. Results: Out of the 1517 total births in the two year period, 22 were still births (SB) and 10 were early neonatal deaths (ENND). Out of the 22 SB, two were of < 1 kg in weight and out of 10 ENND, one was of <1 kg. Thus, perinatal mortality rate during the study period was 19.1 and extended perinatal mortality rate was 21.1 per 1000 births. The important causes of perinatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and associated maternal factors like antepartum hemorrhage and most babies were of very low birth weight. According to Wigglesworth's classification, 43.8% of perinatal deaths were in Group I, 12.5% in Group II, 28.1% in Group III, 12.5% in Group IV and 12.5% in Group V. Discussion: The perinatal death audit done in KMCTH for 1 year period from September 2002 to August 2003 showed perinatal mortality rate of 30.7 and extended perinatal mortality rate of 47.9 per 1000 births. There has been a significant reduction in the perinatal mortality rate in the last 2 years at KMCTH. Main reasons for improvement in perinatal mortality rate were improvement in care of both the mothers and the newborns and the number of births have also increased significantly in the last 2 years without appropriate increase in perinatal deaths. Conclusion: Good and regular antenatal care, good care at the time of birth including appropriate and timely intervention and proper care of the sick neonates are important in reducing perinatal deaths. Prevention of preterm births, better care and monitoring during the intranatal period and intensive care of low birth weight babies would help in further reducing perinatal deaths. Key words: Perinatal mortality rate (PMR), still births, early neonatal death (ENND), Total perinatal death (PND).     

82例妊娠晚期死胎的临床分析

目的探讨妊娠晚期导致胎死宫内的主要原因,制定预防措施,降低围生儿死亡率。方法对昌吉市人民医院2005—2009年收治的82例死胎病例资料进行回顾性分析。结果死胎的原因顺位依次为妊娠并发症、脐带和胎盘因素。结论加强对育龄妇女的孕期保健知识的宣传,加强高危妊娠的监测,对降低围生期母儿死亡率有重要意义。     

125例围生儿死亡原因的临床病理分析

目的:通过临床和病理对照,分析围生儿死亡原因,为防止围生儿死亡提供参考。方法:对围生儿死亡病例进行尸体解剖及病理观察,并结合相关临床资料,分析其死亡原因。结果:125例死亡围生儿中,先天性畸形占36%,脐带及胎盘因素占20%,宫内缺氧和窒息占14.4%,母亲因素占12.8%,感染占7.2%,早产和低体重儿占5.6%,不明原因占2.4%,肿瘤2例,占1.6%。结论:围生儿死亡病例中先天畸形和胎盘脐带因素为主要死亡原因。加强孕期保健和产前诊断,防止妊娠并发症发生,尽早发现畸形儿并及时终止妊娠,是降低围生儿死亡率的关键。     

242例围产儿死亡原因分析

对1979～1988年在我院分娩16079例中242例围产儿的死亡原因进行了分析。新生儿死亡116例,死胎99例,死产27例。尸检102例。围产儿死亡原因以宫内缺氧为主,其次为肺部疾患,先天性畸形等.孕周<37周,体重<2500克,臀位牵引的胎儿死亡率最高.围产儿死亡在产科并发症中主要为脐带因素,其次是胎盘因素,妊高症等.为进一步降低围产儿死亡率,今后必须加强产前保健工作.     

Analysis of high-risk infant births and their mortality: ten years' data from chonnam national university hospital

Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.     

PERINATAL MORTALITY RATE IN 11 JIANGSU CITIES

This prospective collaborative study investigated the perinatal mortality rate and causes of perinatal death in 11 cities in China's Jiangsu Province in the 1 year between September 1, 1980 and August 31, 1981. Of the 86,913 perinatals born during this period, there were 2131 deaths, including 1140 stillbirths and 991 early neonatal deaths, for a perinatal mortality rate of 24.52. Causes of perinatal mortality included hypoxia (37.5%), respiratory disturbance (25.0%), congenital anomaly (11.3%), birth trauma (8.5%), prematurity (6.1%), and miscellaneous or unknown causes (11.6%). These results indicate the importance of the prevention of hypoxia and respiratory disturbance, which together accounted for 62.5% all of perinatal deaths. In the hypoxic category, 54.2% of the deaths were due to umbilical cord factors; in the respiratory disturbance group, 45.6% of deaths were a result of asphyxia neonatorum. Setting up facilities to detect congenital anomalies and determine fetal maturity would further lower perinatal mortality, as would improved fetal monitoring and abandonment of methods of delivery such as version extraction. In the 5 cities south of the Yangzi River, where medical care and living standards are better, the perinatal mortality rate was 21.8-23.8 compared with 24.5-38.4 in the 6 northern cities of the province.     

早产相关因素分析及其围产期处理

目的 探讨早产的病因、围产期处理及早产儿的结局。方法 回顾我院8年的正常分娩病例，对照分析足月产和早产孕妇的年龄、围产因素、分娩方式的差异，比较两组新生儿的出生情况及结局。结果 胎膜早破和体外受精-胚胎移植术后成为早产的最重要原因，妊高征、前置胎盘也是影响早产的因素，而不明原因的早产病例的比例有显著下降趋势，孕产妇的一般情况如年龄、是否经产妇等与足月产相比无差异。早产儿组中剖宫产率增加，Apgar评分≤7分者占67．64％，两组出生情况及分娩方式上有显著性差异。早产儿中缺血缺氧性脑病和吸人性肺炎发病率增高，其死亡率也明显高于足月产儿。结论 积极预防影响胎膜早破的不利因素、控制胚胎移植数目是预防早产的重要措施。加强产前保健，提高对孕产妇状况的综合判断，减少早产的发生，以提高新生儿的生存质量。     

山东省莒县20年孕产妇死亡原因分析

目的 为降低本县孕产妇死亡率提出防治措施。方法 根据县妇幼保健站1978年至1997年20年县,乡医院上报的孕产妇死亡原始记录,对死亡原因及死亡率进行回顾性分析。结果 死亡率35．08／10万,死亡主要原因依次为产科出血（30．69％）,妊高征（14．85％,妊娠合并心脏病（13．86％）,产科感染（11．88％）。结论 加强计划生育工作,认真开展围产期保健,提高孕产妇化,生活水平,提高住院分娩率是降低孕产妇死亡的重要措施;提高基层助产人员对斋危妊娠的诊断,处理水平和对急危重症病人的抢救水平,亦是降低孕产妇死亡的重要手段。     

早产危险因素261例分析

目的探讨早产发生的危险因素和对围生期的影响。方法对我院261例早产孕妇(早产组)与同期随机抽取的261足月孕妇(对照组)进行回顾性比较,分析早产的危险因素及对围产期的影响。结果高龄与未定期产检是早产的相关危险因素。早产的病因中胎膜早破、子痫前期、产前出血、妊娠合并症均多于对照组,两组差异有统计学意义。早产使剖宫产率、新生儿窒息、低体重儿增加。结论定期产前检查、适龄妊娠、提高围产期保健意识可降低早产的发生,提高围生医学质量。     

A 2-year study of neonatal mortality in a large Malaysian hospital

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.     

围产儿死亡因素与围产期保健

目的探讨围产儿死亡因素及早期围产保健对围产儿死亡情况的影响。方法选取2006年4月-2008年5月在赵县医院住院的2859例孕产妇。以2007年后实施早期围产保健的1524例孕产妇作为观察组,以2007年前未实施早期围产保健的1335例孕产妇作为对照组。比较两组的围产儿死亡情况,分析围产儿死亡因素。结果观察组的围产儿死亡率（1．0％）,明显低于对照组（4．7％）（P〈0．001）,先天畸形、新生儿疾病、早产因素是本组病例中围产儿死亡的主要原因。结论围产儿死亡主要与先天畸形、新生儿疾病、早产因素相关;早期围产保健可以明显降低国产儿死亡率。