我国农村孕产妇死亡的流行病学分析

目的 了解1996～2001年我国农村孕产妇死亡率、趋势、主要死因和变化特征。方法在全国31省、自治区、直辖市孕产妇死亡监测网内采用以人群为基础的流行病学调查方法。结果1996～2001年农村孕产妇死亡率由86．4／10万下降到61．9／10万,下降幅度为28．4％;农村孕产妇主要死亡原因为产科出血、妊娠高血压综合征和羊水栓塞等,产科出血死亡率由1996年的48．3／10万下降到2001年的33．0／10万,农村死亡孕产妇主要在家分娩,2001年在家分娩比例为44．6％,在家死亡的比例为30．1％。结论 1996～2001年农村孕产妇死亡率呈下降趋势,产科出血死亡率也呈下降趋势,降低农村孕产妇死亡率的主要措施是减少产科出血,提高住院分娩率。     

十堰市1999-2004年孕产妇死因分析

目的进一步掌握全市孕产妇死亡状况，分析构成孕产妇死亡的相关因素，为制定相应的干预措施提供依据。方法1999—2004年十堰市五县一市三区上报的妇幼卫生统计表、孕产妇死亡报告卡，经质量控制及死亡评审，对结果进行分析。结果1999—2004年孕产妇死亡率分别为：80．94／10万、70．96／10万、62．54／10万、41．96／10万、49．61／10万、51．89／10万。孕产妇死亡前4位死因依次为产科出血、妊高征、妊娠合并心脏病、羊水栓塞。结论6年中孕产妇死亡率前4年逐年下降，近两年略有回升，产科出血死因居首位，可避免死亡占66．67％，创造条件可避免死亡占20．00％。并结合本地实际提出了8项干预措施。     

澜沧县1996～2000年46例孕产妇死亡原因分析

对澜沧县1996年～2000年46例孕产妇死亡资料进行分析。结果表明，5年中，全县活产数25438例，孕产妇死亡46例，平均死亡率180．83／10万，其中，2000年澜沧县孕产妇死亡率为137．17／10万，较1996年的271．11／10万下降50％，引起孕产妇死亡的死因顺位依次为：产科出血、产褥感染、妊高征、妊娠合并心脏病或肝病等。提示开展健康教育，建立健全三级妇幼卫生保健网，加强各级围产期保健人员业务素质及能力的培训，防治产后出血等，是降低孕产妇死亡率的重要措施。     

116例孕产妇死亡分析

本文对1994～1996年间我市七县五区的116例孕产妇死亡进行回顾性分析。3年间活产数153896次，孕产妇死亡116例，死亡率75．38／10万。孕产妇死亡原因中，直接产科死因占88．79％，主要死因依次为产科出血、妊高征、羊水栓塞、心脏病、产褥感染。产科出血占全部死因的56．70％。孕产妇接受保健措施不够，32.76％的孕妇死前未接受过一次产前检查，50．86％的孕产妇未能住院分娩，半数以上的孕妇死于家中和转送途中。     

珠海市1986-2005年孕产妇死亡情况分析

目的回顾珠海市20年来孕产妇的死亡率及死因，分析总结在降低孕产妇死亡率工作中的经验与不足，提出改进措施。方法将珠海市1986-2005年孕产妇死亡情况进行统计、比较、分析。结果①1986-2005年珠海市本地人口孕产妇平均死亡率为25．85／10万，1996-2005年珠海市本地人口与流动人口的孕产妇平均死亡率分别为28．54／10万、78．64／10万。②1986-2005年全市住院分娩率由最低点76．12％逐年上升到99．81％。③孕产妇的主要死因，前10年是产科出血、妊高征、妊娠合并内科疾病；后10年加强了产科建设及高危妊娠的筛查，死亡病种发生了变化，出现病毒性肝炎、麻醉意外、异位妊娠等新病种，羊水栓塞居第一位，20年间以产科出血为死亡原因的孕产妇死亡率逐年下降，产科出血退居第三位。④计划外妊娠占47．7％，无产检占67％，家庭接生占21．1％，家中死亡占52．6％；农村死亡高于城市，分别为65．56％、34．44％。⑤1996-2005年死亡孕产妇的文化程度以初中小学所占42．4％，家庭经济月收入小于100元以下占67．74％。年龄以25～29岁年龄组占40％。创造条件可避免死亡占48．39％。结论重视流动人口的孕产妇保健管理，加强健康教育，加大《中华人民共和国母婴保健法》的执法力度，杜绝非法接生，加强临床医生的专业知识和急救技能培训，充分发挥市孕产妇重症救治中心的作用，是降低我市孕产妇死亡的关键。     

1984～2001年苏州地区孕产妇死亡调查

目的 调查苏州地区围产保健与孕产妇死因的变化，检出孕产妇死亡的高危因素。方法对18年间苏州地区死亡的236例孕产妇进行回顾性分析，按3年划分成六个阶段，进行死亡率与死因比较。结果 苏州市及六个县市，总活产数934433人次，孕产妇死亡236例，死亡率为25．26／10万活产，近阶段与前四个阶段相比，孕产妇死亡率下降50％。初产妇占77．97％。孕28周前有33例死亡，围分娩期孕产妇有203例死亡；前六位死因：产科出血5．24／10万，羊水栓塞3．96／10万，妊高征3．53／10万，心脏病2．25／10万，妊娠期急性脂肪肝2．14／10万，宫外孕2．03／10万；产后出血、妊高征引起的孕产妇死因分别从第一阶段(10．62／10万、5．0／10万)下降到最近阶段(1．82／10万、0．92／10万)。羊水栓塞前移为第一死因。孕产妇死亡的直接产科原因占72．03％。结论 苏州地区自建立围产保健网以来，在产后出血、妊高征的防治与管理方面都取得了显著的成效，羊水栓塞已前移到第一位死因。     

38例孕产妇死亡及相关因素分析

对勐腊县1996—2007年38例孕产妇死亡及相关因素进行分析，结果显示，12年平均孕产妇死亡率为179．03／10万，前3位死因依次为产科出血、妊娠合并内科疾病、妊娠期高血压疾病，产科出血占孕产妇死亡的165．3／10万。经济收入水平低、文化程度低、住院分娩率低、计划外生育、未接受围产期保健、交通不便是影响孕产妇死亡的相关因素。制定贫困地区孕产妇死亡干预措施，重点加强产科建设和围生期保健，降低孕产妇死亡率。     

2001年～2005年孕产妇死亡分析

目的 探讨北京市朝阳区孕产妇死亡相关因素，为降低孕产妇死亡率制定有关政策与措施提供依据。方法对我区2001年～2005年五例孕产妇死亡．及对2001年。2005年我区流动人口17例孕产妇死亡，进行死因及相关因素分析。结果朝阳区五年内，奉区人口孕产妇死亡率为14．93／10万。前三位死亡原因依次为：妊娠离血压综合征、脑出血、异位妊娠。朝阳区五年内流动人口的孕产妇死亡率51／10万。前三位死亡原阂依次为：产科出血、合并内科疾病、羊水栓塞。结论我区的孕产妇死亡主要原因是：产科出血、妊娠高血压综合征、羊水栓塞、异位妊娠、脑出血。需进一步提高产前检查的质量与数量，加强流动人口的孕产妇管理，加强高危孕产妇管理和危重症抢救，可进一步降低我区孕产妇的死亡率。     

1984～1994年常熟市孕产妇死因分析

分析常熟市1984～1994年30例孕产妇死因，年平均孕产妇死亡率为25／10万，死因顺位分别为妊娠合并内科疾病占36．7％，产科出血占30％，异位妊娠占10％意外死亡、羊水栓塞各占0．7％，脑栓塞、产褥感染、精神病各占3．3％。产科出血居第二位，主要是加强围产期保健管理，提高住院分娩率。     

临沂市2002年孕产妇死亡情况分析

目的通过对临沂市2002年孕产妇死亡回顾性调查，总结临沂市孕产妇系统管理的经验和教训，为进一步降低孕产妇死亡率制定相应干预措施提供科学依据。方法采用回顾性调查的方法，对临沂市2002年孕产妇死亡情况进行分析。结果2002午临沂市活产总数98395人，孕产妇死亡37例，孕产妇死亡率为37．71／10万。孕产妇死因顺位：产科出血、羊水栓塞、妊娠并发心脏病、妊娠高血压综合征、妊娠并发肝病、产科感染、肺栓塞、其他。从居住地区、经济状况、文化程度、产龄、孕次胎次、死亡地点、时期及接受妇幼保健措施情况进行分析讨论，并对降低孕产妇死亡率提出建议。     

中国1996～2000年孕产妇死亡监测的流行病学特征分析

目的 了解1996～2000年我国孕产妇死亡发生的主要流行病学特征及城乡差别.方法 在全国31个省、自治区、直辖市孕产妇死亡监测网内采用以人群为基础的流行病学调查方法.结果 1996～2000年全国监测孕产妇死亡1704例,城市341例,农村1363例,城市死亡孕产妇中,69.9%受过中等教育,74.5%居住在平原;农村死亡孕产妇中,73.3%受过初等教育,65.1%居住在山区.全国死亡孕产妇中,76.8%发生在分娩后,49.0%在家分娩,28.9%未接受过产前保健.农村死亡孕产妇中,58.5%在家分娩,35.5%在家死亡,33.1%的分娩由非医务人员接生,31.8%未接受过产前保健.结论 受教育程度低、居住环境偏僻、孕期保健意识薄弱和住院分娩率低是影响我国孕产妇死亡的主要因素.     

Maternal mortality in Papua New Guinea 1976-1983

In April 1970 a Maternal Mortality Register (MMR) was started in Papua New Guinea to record in more detail deaths occurring both at home and in health care facilities. This paper reports 628 maternal deaths for which death certificates were registered and 385 deaths reported to the Maternal Mortality Register (MMR) for the January 1, 1976-December 31, 1983 period. A total of 895 maternal deaths were reported between January 1, 1976 and December 31, 1983. The annual average was 111, but the average number of deaths reported to the MMR was only 48. This represents a marked decrease in the reporting rate from previous reports. The number of deaths reaching the Death Registry (DR) was fairly consistent for the period, and the percentage of hospital and health center deaths registered was high (78-96%). Yet, the number of deaths being notified to the MMR was erratic and considerably less complete (18-55%). Notably, the percentage of deaths notified to both the MMR and the DR has been very low throughout the period (2-22%). It seems that many health workers feel that notification to 1 registry is sufficient. With the marked decline in reporting maternal deaths to the MMR it is more difficult than previously to calculate the maternal mortality rate for Papua New Guinea. A table presents the maternal mortality figures previously reported from the registry. According to Bell (1983) the rate was 1.6/1000 births in urban areas, 10/1000 in rural areas, and 9/1000 overall. The authors of this report think that the rate varies from approximately 2/1000 for urban areas, to 20/1000 in areas without accessible health services. It is probably about 8/1000 overall. According to this estimate, 1/10 of the maternal deaths were reported for the period under review. A table shows the causes of 895 maternal deaths, and another table groups the deaths according to whether they were reported to the MMR or the DR. For 22 of the village deaths and 6 of the institutional deaths it was not possible to determine the cause of death from the information provided. Relatively few deaths from trophoblastic disease, ectopic pregnancy, and abortion were notified to the MMR because of their less obvious "maternal" nature. The causes of death were as follows: puerperal sepsis -- 195 deaths recorded by the DR and 76 by the MMR; postpartum hemorrhage -- 130 recorded by the DR and 102 by the MMR; associated medical and surgical complications -- 140 deaths, which accounted for 26% of the deaths notified to the MMR and only 10% of locatable deaths in the DR; prolonged or obstructed labor (45 deaths) and ruptured uterus (38 deaths), with the MMR showing that primigravidas accounted for 45% of the deaths from prolonged and obstructed labor and grandmultiparas accounted for 60% of the deaths from ruptured uterus; abortion, 38 deaths; antepartum hemorrhage, 36 deaths; eclampsia, 30 deaths; trophoblastic disease, 25 deaths; pulmonary embolus, 25 deaths; actopic pregnancy, 20 deaths; 14 operative and anasthetic deaths; 10 miscellaneous causes of death; and 39 deaths associated with caesarean section.     

疤痕子宫再次妊娠并发妊娠期高血压疾病的妊娠结局分析

目的：探究分析疤痕子宫再次妊娠并发妊娠期高血压疾病的妊娠结局。方法：选取2010年6月至2015年6月该院收治的60例妊娠期高血压产妇为观察对象,其中28例产妇有剖宫产手术史,另选同期60例正常分娩产妇为对照组观察对象。观察并对比三组产妇在产后出血、分娩方式、新生儿并发症、产妇并发症上的差异。结果：妊娠期高血压产妇及疤痕子宫产妇的产后出血量、剖宫产率、并发症发生率明显高于对照组产妇（P＜0.05）。结论：疤痕子宫产妇在妊娠期间并发高血压,能够对妊娠结局产生不利影响,应在围产期加强观察,选择合适的分娩方式,预防并发症的发生。     

妊娠期肝内胆汁淤积症412例临床分析

目的:观察妊娠期肝内胆汁淤积症对围生儿预后的影响及危害。方法:对本院412例住院分娩的妊娠期肝内胆汁淤积症病例进行回顾性分析,并与正常孕妇对照研究。结果:412例妊娠期肝内胆汁淤积症中早产97例占39.6%、胎儿宫内窘迫139例占33.7%、新生儿窒息56例占13.6%、产后出血63例占15.3%。对照组的早产27例占6.6%、胎儿宫内窘迫40例占9.7%、新生儿窒息24例占5.8%、产后出血31例占7.5%。两组各项发生率比较,P<0.01有显著差异。结论:妊娠期肝内胆汁淤积症严重影响围生儿的预后,应早期诊断,积极治疗,降低围生儿发病率及病死率。     

Maternal and perinatal mortality

A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved socioeconomic standards, better obstetric and pediatric services, education of the public to use such services, and treatment of diseases complicating pregnancy and research. The clinical and practical aspects of obstetric care are the most important areas in training undergraduates. For existing facilities to yield maximum benefits, hospital deliveries should be restricted to high risk patients. To accomplish this, closer integration of the hospital and domiciliary services is necessary.     

基层医院剖宫产指征与结局的研究

目的:探讨基层医院剖宫产指征与结局的关系。方法:回顾性分析1134例产妇剖宫产指征及结局。结果:我院2009年1月～2012年12月平均剖宫产率为27.3%,部宫产率呈逐年上升的趋势,2012年(31.3%)高于其它3年,但差异无统计学意义(P>0.05)。剖宫产指征前5位分别是胎儿宫内窘迫、羊水过少、胎膜早破、社会因素、子痫前期等为主。1134例剖宫产中,9例围产儿死亡,围产儿死亡率7.9‰。产妇无1例产妇死亡,产妇并发症中产后出血26例(2.3%),产褥感染及产褥病率23例(2.0%),腹部切口愈合不良8例(0.7%),晚期产后出血5例(0.4%)。其中7例(0.6%)腹部切口愈合不良或感染患者行2次手术。结论:剖宫产率呈逐年上升趋势,基层医院应合理掌握剖宫产指征,在保证母婴平安的前提下,尽量鼓励产妇选择阴道分娩方式。     

660例高危妊娠孕产妇住院分娩情况分析

目的 分析高危孕产妇的高危因素及分娩情况.方法 回顾性分析2004年1～12月住院分娩1980例孕产妇,其中高危妊娠孕产妇660例,发生率为33.3%.结果 高危孕产妇剖宫产505例,剖宫产率占住院分娩总数的25.5%,占高危妊娠产妇的76.5%;产后出血23例,占高危孕产妇的3.74%;子宫切除4例,占高危孕产妇的6‰;围产儿死亡15例,占高危孕产妇的24.8‰,占总住院分娩总数的7.6‰.结论 加强高危妊娠管理,严格三级转诊制度,最低限度地减少高危妊娠的发生,改善妊娠结局,降低孕产妇和围产儿的死亡率.     

阴道分娩产后出血应用预见性护理的效果观察

目的:观察分析阴道分娩应用预见性护理降低产后出血的效果.方法:我院在2014年-2016年入院实施阴道分娩的产妇筛选215例为本次研究对象,按照入院时间的先后,护理方式的不同分成两组,常规组和研究组,常规组使用常规护理方法的对产妇,研究组使用预防性护理干预模式,对比两组产妇产后的出血率以及出血量.结果:研究组产妇产后出血占3.67%(4/109)发生率,常规组产妇产后出血占15.09%(16/106)发生率,两组比较差异显著,P<0.05,具有统计学意义.研究组产妇对护理达到93.58%(102/109)的总满意率,常规组产妇对护理达到83.96%(89/106)的总满意率,两组比较差异显著,P<0.05,具有统计学意义.研究组产妇产后出血量为(721.92±142.86)ml;常规组产妇产后出血量为(1108.68±231.57)ml;研究组产妇产后出血量明显低于对照组,P<0.05,具有统计学意义.结论:阴道分娩应用预见性护理降低产后出血的效果显著,产后出血发生率以及出血量大大降低,产妇的护理满意度大大提高,且有效的提高产妇的分娩安全,值得临床推广.     

多类反应结果的logistic回归在产后出血影响因素分析中的应用

To determine the role of history of induced abortion and pregnancy induced hypertension in postpartum hemorrhage, a polychotomous logistic regression method was introduced to analyze the data gathered in an investigation of blood loss among 933 parturients in some counties of Sichuan and Ningxia provinces. The results show that postpartum hemorrhage caused by placenta factors is related to a history of induced abortion and pregnancy induced hypertension with relative risks 2.55 (95% confidence interval = 1.2-5.3) and 4.94 (95% confidence interval = 1.8-13.2), respectively. An increased risk was noted for postpartum hemorrhage associated with pregnancy induced hypertension (relative risk = 2.58, 95% confidence interval = 1.3-5.2), but not with induced abortion. Suggestions were made for prevention of postpartum hemorrhage.