摘要
目的总结天津市2011年至2020年孕产妇死亡率(maternal mortality ratio, MMR)的变化趋势和孕产妇死亡原因, 以指导孕产妇的保健管理。方法回顾性收集2011年至2020年天津市全部孕产妇死亡病例(89例)及评审资料, 分析MMR的变化趋势、死亡原因顺位及死亡评审结果。采用χ^(2)检验进行统计学分析。结果 (1)MMR的变化趋势:10年天津市平均MMR为7.97/10万, 各年MMR呈波动式下降, 2014年最高(12.61/10万), 最低为2019年(3.85/10万)。(2)死亡孕产妇的特征:非本市户籍死亡孕产妇高龄、无稳定职业/无业、大专以下学历、经产妇、未建立孕产妇保健手册的比例均高于本市户籍者[33.33%(8/24)与20.00%(13/65), χ^(2)=46.18;100.00%(24/24)与69.23%(45/65), χ^(2)=9.53;87.50%(21/24)与64.62%(42/65), χ^(2)=4.44;79.17%(19/24)与44.62%(29/65), χ^(2)=8.42;75.00%(18/24)与13.85%(9/65), χ^(2)=31.02;P值均<0.05]。(3)孕产妇的死亡原因:直接产科死亡占57.30%(51/89), 间接产科死亡占42.70%(38/89)。死因顺位的前5位依次为产后出血、妊娠期高血压疾病、猝死、静脉血栓形成及肺栓塞症、羊水栓塞。(4)孕产妇死亡评审结果:可避免的孕产妇死亡占39.33%(35/89), 其中直接产科死亡占94.29%(33/35), 间接产科死亡占5.71%(2/35)。(5)可避免孕产妇死亡的主要影响因素是医疗保健系统的知识技能问题[62.86%(22/35)], 且集中在区县级及以下医疗机构[86.36%(19/22)]。结论应加强区县级及以下医疗机构能力建设和流动人口的孕产期保健管理, 以保障母婴安全, 进一步降低MMR。
Objective:To analyze the trend of maternal mortality ratio(MMR)and death causes in Tianjin from 2011 to 2020 and to guide the management of maternal health.Methods:All the reviews data of 89 maternal death cases in Tianjin from 2011 to 2020 were retrospectively collected to analyze the trend of MMR,rank order of death causes,and death review results using Chi-square test.Results:(1)The average MMR in Tianjin was 7.97/100000 during the study period,showing an overall fluctuating decline.The highest MMR was 12.61/100000 in 2014 and the lowest was 3.85/100000 in 2019.(2)Among the dead pregnant women and parturients,non-registered residents had higher proportion of women with advanced age,no steady occupation/unemployment,below junior college education,multipara,or without maternal health manual compared with the registered residents[33.33%(8/24)vs 20.00%(13/65),χ^(2)=46.18;100.00%(24/24)vs 69.23%(45/65),χ^(2)=9.53;87.50%(21/24)vs 64.62%(42/65),χ^(2)=4.44;79.17%(19/24)vs 44.62%(29/65),χ^(2)=8.42;75.00%(18/24)vs 13.85%(9/65),χ^(2)=31.02;all P<0.05].(3)Direct obstetric factors and indirect factors that caused death were accounted for 57.30%(51/89)and 42.70%(38/89).The top five death causes were postpartum hemorrhage,hypertensive disease during pregnancy,sudden death,venous thrombosis and pulmonary embolism,and amniotic fluid embolism.(4)In terms of the maternal death review results,39.33%(35/89)of maternal deaths were avoidable,among which 94.29%(33/35)were caused by direct obstetric factors and 5.71%(2/35)were indirect.(5)The main influencing factors of avoidable death causes were knowledge and skills inadequacy in the health care system(62.86%,22/35),of which 86.36%(19/22)happened in health facilities at and below the district/county level.Conclusion:It is suggested to strengthen the medical care of health facilities at and below the district/county level and the maternal health management of the non-permanent residents to ensure maternal and infant safety and to further reduce the MMR.
作者
孙淑荣
董微
张爽
王晓静
王鹏
Shurong Sun;Wei Dong;Shuang Zhang;Xiaojing Wang;Peng Wang(Department of Women Health Administration,Tianjin Women's and Children's Health Center,Tianjin 300070,China;Project Office,Tianjin Women's and Children's Health Center,Tianjin 300070,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2022年第4期241-247,共7页
Chinese Journal of Perinatal Medicine
关键词
产妇死亡率
死亡原因
回顾性研究
天津
Maternal mortality
Cause of death
Retrospective studies
Tianjin
