Perinatal mortality audit at Tikure Anbessa Teaching Hospital,Addis Ababa,Ethiopia: 1995 to 1996

Objectives

To determine the prevalence and causes of perinatal mortality rates at Tikure Anbessa hospital, Ethiopia, 1995–96

Design

A cross-sectional review of hospital records of all women who delivered at Tikure Anbessa Hospital. Data were collected prospectively.

Setting

Teaching Hospital of Tikure Anbessa, Addis Ababa, Ethiopia

Subjects

Women and neonates from 8986 deliveries. Deliveries exceeding 28 weeks of gestation or birth weight of 1000 grams were considered.

Materials and Methods

All deliveries were included for infants whose gestational age exceeded 28 completed weeks. When the gestational age was unknown, the birth weight of 1000 grams or more was considered. All perinatal deaths and obstetric complications were identified. Labour chart, mode of delivery and summary of delivery had been recorded by the responsible resident at a monthly combined obstetric and paediatric perinatal mortality meeting. Age of the mother, parity, booking status for antenatal care, obstetric complications, labour, mode of delivery, birth weight, gestational age, one and five minutes Apgar scores were collected.

Results

A total of 8986 deliveries were conducted during the study period. Of these 6933 (77.2%) were booked for antenatal care while the remaining 2053 (22.8%) were not booked in any health institution. The perinatal mortality rate of the hospital was 71.6 per 1000 live births. The risk of perinatal mortality was more than doubled among mothers who failed to book for antenatal care follow-up and no laboratory investigations was done were birth asphyxia followed by premature birth 15.4% and 12% respectively.

Conclusions

Perinatal mortality rates are high at Tikure Anbessa Hospital, Ethiopia. There is need to ensure that pregnant women are booked for antenatal care so as to provide adequate antenatal and perinatal health care.     

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).     

52例足月低体重儿临床分析

目的探讨足月低体重儿围产期的影响因素。方法对52例足月低体重儿临床资料进行回顾性分析。结果双胎妊娠、妊高症、妊娠期胆汁淤积症、先天性遗传代谢病是引起足月低体重儿的主要因素。足月低体重儿与正常体重足月儿相比,并发症及死亡率均明显升高。从本资料的统计可以看出,足月低体重儿21-三体综合症和先天性畸形发生率较正常体重新生儿明显增高,两者相比差异有统计学意义。结论足月低体重儿病因较复杂,临床并发症多样。加强孕产期保健,对出现异常围产因素的孕母尽早干预,对高龄产妇及有遗传性疾病家族史人群应积极普遍推广孕早期羊水细胞或绒毛膜细胞染色体检测是降低足月低体重儿出生、提高足月低体重儿的生命质量和降低远期发病率的关键。     

瑞安市2003～2009年围产儿死亡影响因素分析

目的研究瑞安市2003～2009年围产儿死亡影响因素,提出有针对性的干预措施以提高围产儿出生质量。方法回顾性分析2003～2009年上报的围产儿资料及围产儿死亡资料,分析围产儿死亡率及其影响因素。结果围产儿平均死亡率为6.95‰。其中死胎、死产、早期新生儿死亡分别占68.12%、6.47%、25.41%,各年围产儿死亡率、死胎、死产率均无显著差异(P>0.05),早期新生儿死亡率差异有统计学意义(P<0.05)。在围产儿死亡原因中:死胎的前3位原因为先天畸形、脐带因素、死因不明;死产前3位原因为脐带因素、胎盘因素、胎儿窘迫;新生儿死亡前3位原因为早产和低体重儿、先天畸形、新生儿窒息。流动人口围产儿死亡率明显高于本地围产儿死亡率;农村户籍、低学历者、产检次数少的孕产妇,其围产儿死亡率均高于城市户籍、高学历者、产检次数多的孕产妇。随孕周的增加与胎儿体重的增长,围产儿死亡率也降低。结论加强围产期保健管理工作,做好优生优育的宣教,减少出生缺陷,进一步提高产科质量以及新生儿科医疗质量水平是降低围产儿死亡率的重要措施。     

Predictors of mortality in very low birth weight neonates in India

INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock.     

Rates of perinatal mortality and low birth weight among 3367 consecutive births in south of Beirut

3367 consecutive births were reviewed prospectively. Population belongs mainly to a community with relatively underprivileged living conditions. Perinatal mortality was found at a rate of 22.4/1000 B. Early neonatal mortality formed 6.66/1000 B and stillbirth formed 15.83/1000 B. Low birth weight rate was 5.43% of live birth. Analysis of our findings suggests the need to improve follow-up during gestation to avoid complications resulting in macerated stillbirths, and to review the routine of follow-up and care in the immediate period before delivery, during delivery, in the immediate post partum period including resuscitation procedures, and care in the ICN. The aim is to prevent and appropriately treat intrauterine asphyxia, fetal distress, obstetric complications, and in the post partum period to appropriately resuscitate the newborn and improve ICN procedures. These measures are expected to reduce fresh stillbirth and early neonatal mortality and consequently infant mortality. Lowering rate of low birth weight is of less urgent nature in this population as it is relatively not high, but because a larger portion of early neonatal mortality is among low birth weight infants, with weights below 2000 gms, improving ICN care provided to these neonates is expected to sharply reduce neonatal mortality. In Lebanon we have a growing number of ICN units with wide variability of the quality of medical supervision and facilities. Insufficient number of neonatologists and nurses who are specialized in neonatal intensive care is leaving the chance for sick neonates to be attended by general pediatricians and insufficiently trained nurses. Our medical schools are called to encourage pediatricians to specialize in neonatal intensive care and to create more opportunities for this specialty to meet the national requirement. It is suggested, too, to subject ICN units in Lebanon to standardized requirements concerning attendance and facilities before obtaining official recognition. Centralization of care given to severely sick neonates and to women with high risk pregnancy in optimal conditions is most needed.     

双胎妊娠围生期处理与围生儿分析

目的探讨双胎妊娠的围生期处理及影响妊娠结局的因素，为双胎妊娠的围生保健和并发症的防治提供参考。方法回顾性分析在我院住院分娩的99例双胎妊娠产妇的临床资料。结果双胎妊娠并发症发生率高，早产49．5％，妊娠期高血压疾病28．3％，贫血19．2％，胎膜早破25．3％。新生儿窒息率和围生儿死亡率随着双胎妊娠孕周的增加而下降，早产组与足月妊娠组比较，差异有统计学意义（P〈0．05）。阴道分娩组及阴道助产组新生儿窒息率明显高于剖宫产组，差异有统计学意义（P〈0．05）。阴道分娩组及阴道助产组围生儿死亡率也明显高于剖宫产组。分娩孕周及出生体重是影响围生儿预后的主要因素。结论双胎妊娠并发症、合并症发生率及围生儿死亡率均较高，早产及妊娠期高血压疾病是主要并发症。为降低新生儿窒息率和围生儿死亡率，应加强围生期保健，积极防治并发症，尽量延长孕周，选择适当的分娩时机和分娩方式，且适当放宽剖宫产指征。     

Some perinatal risk factors in a developing country

Mothers attending the antenatal clinic and the under-5 clinic at Katangi Dispensary in rural Kenya were carefully interviewed about their obstetrical history to elucidate the importance of certain obstetrical risk factors. Women with suspected twins and women with previous perinatal deaths were found to constitute high risk groups. Perinatal mortality was found to be higher for all children born after a short birth interval than for children born after an interval of more than 3 years. The parity and age of the mother did not have any influence on the perinatal mortality. As the perinatal mortality was found to be high as in many other developing to hospitals for delivery and to follow up all women at risk carefully. The majority of women still give birth at home, a reason for which local clinics should be giving instructions at the antenatal in safer performance of deliveries and in proper umbilical cord care.     

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。     

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.     

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.     

Neonatal outcome of children born to women with tuberculosis

BACKGROUND: As the incidence of tuberculosis (TB) has increased worldwide, it is expected that pregnant women will acquire this infection more frequently. Mycobacterium tuberculosis infection during pregnancy may represent a risk for maternal and neonatal complications. METHODS: We studied the perinatal events of 35 consecutive pregnancies complicated by TB from March 1990 to June 1998; 105 apparently healthy pregnant women were included as controls, matched in age, gestational age upon arrival at the Institute, and socioeconomic status. Frequency and type of neonatal complications were recorded. Relative risk (RR) with 95% confidence interval (CI) was calculated. To control potentially confounding variables, a stratified analysis was performed. RESULTS: Seventeen (48.5%) tuberculous mothers had a pulmonary infection and 18 (51.5%), an extrapulmonar localization of the TB. The neonatal morbidity rate in children born to women with TB was 23% against 3.8% of the children of the control cohort (p <0.05). Average weight of newborn infants of tuberculous mothers was 2,859 +/- 78.5 g, while average weight at birth of control neonates was 3,099 +/- 484 g (p = 0.03). Newborns of women with TB had a higher risk of prematurity (RR 2.1; 95% CI 1-4.3), perinatal death (RR 3.1; 95% CI 1.6-6), and weight at birth less than 2,500 g (RR 2.2; 95% CI 1.1-4.9). Pulmonary localization of the TB and late start of the treatment in the mothers increase the risk of perinatal death and neonatal morbidity. CONCLUSIONS: Children born to women with TB have an increased risk of morbidity and mortality in the neonatal period.     

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.     

重度妊高征近十年发病情况及其相关因素的分析

对１９８６￣１９９５年我院内分娩的重度妊高征病人，通过Ｌｏｇｉｓｔｉｃ多元回归分析其人群构成比及母儿合并症的相关因素，提出重度妊高征高危险人群集中于经济状况差、来源于外源及孕期检查少的孕妇，其母儿合并症明显高于对照组。虽然近５年重度妊高征组早产率、低体重儿分娩率有所上升，但由于围产医学发展，围产儿死亡率并未随之上升，由此本文探讨了相应的围产保健措施。     

198例早中期早产临床资料分析

目的对198例早中期早产临床资料分析,探讨早期早产危险因素及早产儿结局。方法回顾性分析该院2004年1月～2006年9月收治的198例分娩孕龄28～33 6周的早中期早产活产孕妇和早产儿的临床资料,分为孕龄28～3l 6周的早期早产活产组90例,早产儿99例;孕龄32～33 6周的中型早产活产组108例,早产儿122例(出生致死性缺陷除外),进行早产原因及新生儿结局对比分析。结果早产的发生受多因素影响,早期早产组规律产检率、妊娠期体质量增加均明显低于中型早产组(P<0.05);早期早产组剖宫产率、住院天数较中型早产组明显增加(P<0.05)。早期早产组新生儿1 min和5 min Apgar低评分、新生儿呼吸窘迫综合征和新生儿低钙血症发生率、NICU住院日、新生儿死亡率均明显高于或长于中型早产组(P<0.05)。结论早期早产的发生受多种因素的影响,早期早产新生儿发病率和死亡率均高;孕妇规律产检及孕期均衡营养、控制孕期体质量增长过多或过少对减少早期早产的发生具有重要的意义。     

Is perinatal care in southwestern Ontario regionalized?

OBJECTIVE: To determine whether perinatal care in southwestern Ontario is regionalized, to identify trends over time in referral patterns, to quantify trends in perinatal death rates and to identify trends in perinatal death rates that give evidence of regionalization. DESIGN: Cohort study. SETTING: Thirty-two hospitals in southwestern Ontario (1 level III, 1 modified level III and 30 level II or I). PATIENTS: All pregnant women admitted to the hospitals and their infants. MAIN OUTCOME MEASURES: Antenatal and neonatal transfer status, live-born with discharge home alive from hospital of birth, stillborn, and live-born with death before discharge. RESULTS: Between 1982 and 1985 the antenatal transfer rate increased from 2.2% to 2.8% (p less than 0.003). The proportion of births of infants weighing 500 to 1499 g increased from 49% to 69% at the level III hospital. The neonatal transfer rate increased from 26.2% to 47.9% (p less than 0.05) for infants in this birth-weight category and decreased from 10.2% to 7.1% (p less than 0.03) for infants weighing 1500 to 2499 g. The death rate among infants of low birth weight was lowest among those born at the level III centre and decreased at all centres between 1982 and 1985. CONCLUSIONS: Perinatal care in southwestern Ontario is regionalized and not centralized; regionalization in southwestern Ontario increased between 1982 and 1985.     

双胎选择性胎儿生长受限的妊娠结局分析

目的 分析双胎选择性宫内生长受限的妊娠结局.方法 回顾性分析活产分娩的双胎妊娠127例临床资料,以双胎胎儿体重差≥25％为诊断标准,分为研究组及对照组比较两组间孕妇一般情况、妊娠期并发症、新生儿出生体重、新生儿窒息率、围产儿死亡率及入住NICU情况等方面的差异.结果 研究组妊娠期高血压疾病的发生率为26.1％,高于对照组的7.69％ （P＜0.05）.研究组剖宫产分娩18例,占78.3％;对照组剖宫产分娩90例,占对照组总数的86.5％,两组比较差异无统计学意义（P＞0.05）.研究组分娩胎儿46例,其中小于胎龄儿21例,占46.5％;新生儿平均出生体重、新生儿窒息率、围产儿死亡率、新生儿入住NICU比率明显高于对照组,差异有统计学意义（P＜0.05）.结论 选择性宫内生长受限双胎的围生儿患病率和死亡率明显高于发育一致性双胎,及早发现和处理选择性宫内生长受限双胎,是改善胎儿和新生儿预后的关键.     

运用多元Logistic回归模型分析影响新生儿低血糖的危险因素

目的 探讨影响新生儿低血糖的危险因素。方法 回顾性分析了2013年7月~2015年7月入住本院的340例新生儿的临床资料,根据新生儿血糖浓度进行分组,将血糖浓度＜2.2 mmol/L为低血糖组,其中新生儿低血糖组32例,正常新生儿组308例。分别采用Pearson单因素与多元Logistic回归模型分析影响低血糖新生儿的相关危险因素。结果正常新生儿组与低血糖新生儿组在新生儿出生情况(出生体重、早产儿、足月小于胎龄儿)、母亲围生期情况(母亲年龄、妊高症)及新生儿合并症(合并呼吸系统疾病、新生儿窒息、先心病、出血性疾病、感染性疾病、高胆红素血症、甲减)方面的差异均具有统计学意义(P＜0.05)。影响新生儿低血糖相关危险因素:新生儿出生情况(出生体重、早产儿、足月小于胎龄儿)、母亲围生期情况(母亲年龄、妊高症)、新生儿合并症(新生儿窒息、先心病、高胆红素血症)。结论影响新生儿低血糖相关危险因素为:出生体重、早产儿、足月小于胎龄儿、母亲年龄、妊高症、新生儿窒息、先心病、高胆红素血症,控制这些因素为有效预防新生儿低血糖提供科学依据。     

2013—2016年北京市朝阳区高危妊娠情况及干预措施探讨研究

目的　分析北京市朝阳区高危妊娠情况并探讨干预措施,为有效降低孕产妇及围生儿病死率提供科学依据。方法　收集2013—2016年朝阳区基层卫生服务机构上报的《孕产妇保健健康情况年报》《孕产妇保健情况调查表率表》及北京市妇幼保健网络信息系统的《北京市围产保健管理登记册》孕产妇个案信息,将其分为高危孕产妇组及对照组（正常孕产妇）,收集高危孕产妇管理情况、产检情况、高危因素情况、分娩结局、孕产妇死亡情况。结果　2013—2016年朝阳区孕产妇共141 702例,高危孕产妇85 544例（60.37%）,高危孕产妇管理人数85 452例（99.89%）;高危孕产妇《北京市母子健康档案》建立时间：在孕l3周前68 009例（79.50%）,孕13~27周13 434例（15.70%）,孕28周后4 101例（4.80%）。未产检的高危孕产妇逐年减少,产检>5次的孕产妇逐年增加;高危孕产妇组死胎死产发生率、早期新生儿病死率均高于对照组（P<0.05）;2013年高龄、巨大儿、流产≥2次位居高危因素的前3位,2014—2016年高龄、瘢痕子宫、糖代谢异常/糖尿病位居高危因素的前3位;6例孕产妇死亡中,5例孕产妇在妊娠期间具有不同的高危因素。结论　高危孕产妇逐年增加,而产检>5次的孕产妇也逐年增加,因此通过严格筛查,实行孕产妇全覆盖管理,加强围生期监护,提高孕期保健及监测质量,有效、充分发挥社区卫生服务机构-区妇幼保健机构-各助产机构全程动态三级管理模式的功能,提高产科质量,降低高危妊娠的发生率,从而降低孕产妇、围生儿病死率。     

高原与平原地区围产期保健相关因素分析

目的研究高原地区产妇孕期保健及产科干预措施与平原地区的差异,以期提高高原地区的产科质量。方法收集并总结2009年10月-2010年9月高原地区（高原组）及平原地区（平原组）住院分娩产妇667例的临床资料,将孕期保健、产科并发症、剖宫产率及围产儿出生等相关情况进行多因素分析。结果高原组产妇孕期定期产前检查率（10.34%）显著低于平原组（94.67%）,P〈0.01;妊娠期高血压病、羊水过少为高原组产科并发症前两位,发生率分别为13.34%和9.15%,显著高于平原组（P〈0.01）;高原组剖宫产率（20.54%）低于平原组（40.17%）,P〈0.01;高原组足月新生儿平均出生体质量（3 095.17±433.53）g低于平原组（3 487.32±468.89）g,P〈0.01;高原组新生儿窒息率（5.10%）、早期新生儿死亡率（0.75%）、足月低出生体重儿发生率（5.85%）均高于平原组,P〈0.05。结论普及妇幼卫生知识,加强孕产妇系统管理,积极防治产科并发症特别是妊娠期高血压和羊水过少,提高医疗技术及加大必要医疗设备投入,是提高高原地区产科质量的重要措施。