广东省2001-2002年急危重症孕产妇及相关并发症流行病学调查

目的了解广东省孕产妇急危重症及相关并发症的发病规律,分析妊娠高血压综合征（妊高征）和产后出血的危险因素.方法采用普查和病例对照相结合的方法,普查采取在全省乡镇以上有产科的医院登记所需数据,然后逐级上报;病例对照研究是选取2家不同级别的妇幼保健院,以2001年和2002年住院的所有妊高征和产后出血患者作为病例,采用病历过录的方法获得资料.结果2001-2002年广东省产科急危重症中产后出血（48.22%）和妊高征（43.76%）,共占90%以上;从不同级别和不同经济水平的地区发现率来看,除羊水栓塞外,其他各种疾病发现率的差异均有统计学意义（P＜0.001）,表明在级别较高和经济较发达的地区产科急危重症的发现率较高;孕次较少、异常感觉发生的孕周较晚、既往有产科并发症、孕期有内科合并症等是妊高征发生的主要危险因素;较多产次、胎盘较长、人工剥离胎盘、胎盘滞留等是产后出血的危险因素,居住地为平原、阴道产、新生儿早吸吮等为产后出血的保护因素.结论广东省产科处理急危重症的技术水平有待进一步提高,特别是基层和经济落后地区的医疗保健机构;另外对于妊高征和产后出血的处理和预防需要加强,应该针对高危因素制定合理的预防策略.

An epidemiological survey on obstetric emergency and relative complications in Guangdong province

Objective To understand the epidemiological status on obstetric emergency and relative complications in Guangdong province and to analyse the risk factors of pregnancy-induced hypertension (PIH) syndrome and postpartum haemorrhage in order to provide scientific evidences to set up further preventive strategy for decreasing the rate of maternal mortality. Methods Screening and a case-control study were adopted. Data on screening was registered in the township and secondary hospitals throughout the province and submitted upgradedly. Case-control study was conducted by extracting information from medical record including all of PIH and postpartum haemorrhage in-patients in two different ranking maternal and child health hospitals in 2001 and 2002. Results Most of the emergency of obstetrics and relative complications were postpartum haemorrhage (48.22% ) and pregnancy induced hypertension (PIH, 43.76%) in 2001 and 2002, and totally accounted for more than 90% of the patients. There were different prevalence rates on obstetric emergencies and complications in the different economic areas ( P < 0.001) with higher level of economic development areas having higher rates of prevalence. Less gravidity, abnormal felt in later pregnant week, obstetrics complication history, and with internal diseases during pregnant time were the risk factors on PIH. More parity, longer placent, placental delivery by hand, placental retention were the major risk factors on postpartum haemorrhage while living in plain area, delivery through vagina, earlier sucking by neonate were protective factors on postpartum haemorrhage. Conclusion The ability of treating emergency of obstetrics in Guangdong province should be improved, and especially to primary medical establishment and poor areas. The preventive measures on PIH and postpartum haemorrhage should be strengthened, and the preventive measures should aim at risk factors.