降低密云县孕产妇死亡干预措施的研究

母亲安全是当今世界各国关注的重要问题.我国政府向世界承诺了到2000年孕产妇死亡率下降50%,密云县的研究是WHO 母亲安全研究项目之一。通过对1985～1988年的孕产妇死亡回顾分析,死亡漏报率为27.3%,出生漏报率为18%,并找出死亡漏报的原因。纠正后孕产妇死亡率为114/10万,几乎为北京市平均孕产妇死亡率的3倍,也稍高于全国的94.1/10万。又采用美国、挪威和WHO 的方法进行孕产妇死亡病例的综合评审。宏观评审得知,造成孕产妇死亡的第1位因素是孕妇、家庭、居民团体及医疗保健人员的知识和技能问题,占72.7%;性质评审结果是可避免死亡占39.7%;直接产科原因占死因构成的60.6%,其中产科出血占第1位,产褥感染和妊高征为第2、3位;特征分析中,发现产前检查少于3次者占63.6%,死亡时间在产时及产后占72.7%。根据调查研究结果,制定了有针对性的降低孕产妇死亡率的干预措施。

Study of intervention measures for loweringmaternal mortality for safe motherhood in Miyun County of Beijing City

Safe Motherhood is an important problem to which great attention has been paid all over theworld.China government had made the commitment to the world that the maternal mortality isto be reduced 50% by 2000.This study is one of the WHO Safe Motherhood Programmes.Theretrospective investigation of the maternal mortality rate in 1985～1988 revealed-that there were27.3% of failed to report in maternal mortality and 18% in birth registration.After correctionthe maternal mortality rate was 114/100000 which was 3 times of the total Beijing average ma-ternal mortality rate and higher than the average national value of 94.7/100000.The audit of themortality cases was made with the synthetic method of USA,Norway and WHO.By the macro-scopic audit it was found that the first factor of death was the problem in the knowledge and skillof the pregnant women,family,neighborhood and medical system which composed 72.7%.Theaudit of the nature revealed that 39.7% was avoidable deaths and 60.6% due to direct obstetriccauses out of which puerperal hemorrhage ranked first,puerperal infection and pregnancy inducedhypertension ranked second and third respectively.The analysis of the charateristics showed that63.6% had prenatal examination less than 3 times and 72.7% died in labor and puerperium.Based upon the analyses measures of intervention were formulated.