上海市20年剖宫产产妇死亡原因分析

目的 了解剖宫产产妇死亡原因及剖宫产潜在危险性，以降低剖宫产产妇死亡率。方法 对上海市１９７８～１９９７年间剖宫产产妇死亡病例资料进行回顾性分析。结果 （１）１９７８～１９８７年的剖宫产率为１５．５５％（２５８１５８／１６５９８９２），显著低于１９８８～１９９７年的２９．３９％（３６５３７６／１２４３３３７），两者比较，差异有极显著性（Ｐ〈０．０１）。（２）２０年间产妇死亡４３０例，其中剖宫产产妇

Analysis on Maternal Deaths of Cesarean Section in Shanghai

OBJECTIVE: To analyze the causes of maternal deaths of cesarean section and the potential risks of it. METHODS: A retrospective study on maternal deaths of cesarean section from 1978 to 1997 was carried out. RESULTS: (1) The rate of cesarean section in 1978-1987 was 15.55% (258,158/1,659,892), which was significantly lower than that of 29.39% (365,376/1,243,337) in 1988-1997 (P < 0.01). (2) During the 20 years there were 430 cases of maternal deaths in Shanghai. Among them, 150 cases were maternal death after cesarean section which accounted for 34.88%. (3) Maternal mortality rate of cesarean section cases was 24.05/10(5)(150/623,534) which significantly higher (P < 0.01) than that of vaginal delivery, 12.28/10(5)(280/2,279,695). The relative risk of maternal deaths in cesarean section group increased when the cesarean section rate was over 30.00%. (4) The rank order of maternal deaths of cesarean section was as follows: PIH (pregnancy induced hypertension), Cardiac diseases, embolisms, haemorrhage, hepatic diseases, and infections. (5) The relative risk of PIH death either for cesarean section or for vaginal delivery was significantly decreased in 1988-1997, compared to the former 10 years. (6) Of 150 cases of maternal deaths of cesarean section, 43 cases (28.67%) were related to the cesarean section with embolism ranking the first, haemorrage the second and infection the third. CONCLUSIONS: In order to reduce maternal mortality of cesarean section, it is important to pay attention to (1) the prevention and treatment of PIH, heart diseases and embolisms, (2) the indications of cesarean section, (3) improvement of the quality of cesarean section, and (4) pre- and post-operational management.