贵州省实施“降低孕产妇死亡率和消除新生儿破伤风”项目对孕产妇死亡率和死亡原因的影响分析  

Safe Motherhood Project on maternal mortality ratio and maternal death in Guizhou Province

作　　者：冯海哲[1] 张玉琼[1] 李艳萍 张谊[1] 韩燕[1] FENG Hai-zhe ZHANG Yu-qiong LI Yan-ping ZHANG Yi HAN Yan(Guizhou Province Center for Disease Control and Prevention, GuiYang 550004, Chin)

机构地区：[1]贵州省疾病预防控制中心,贵州贵阳550004 [2]贵州省卫生计生委

出　　处：《实用预防医学》2017年第10期1153-1156,共4页Practical Preventive Medicine

基　　金：贵州省卫生计生委科学技术基金项目(gzwjkj2015-1-005)

摘　　要：目的评价"降低孕产妇死亡率和消除新生儿破伤风"(以下简称"降消")项目对贵州省项目地区孕产妇死亡的影响。方法利用贵州省项目县历年上报孕产妇死亡数及死亡报告卡资料,描述分析"降消"项目实施前后孕产妇死亡模式的变化。结果 (1)"降消"实施以来,项目县住院分娩率由1999年的17.08%增加到2014年的98.48%,孕产妇死亡率由144.79/10万降低到29.44/10万。(2)产科出血、妊娠高血压综合征、羊水栓塞在整个项目期间一直是孕产妇死亡的主要原因,2010年住院分娩率提高到90%以上后,孕产妇死亡原因发生重要变化:产后出血、妊娠高血压综合征发病降低,肝静脉血栓形成和肺血栓居孕产妇前5位死亡原因;(3)产科出血死亡孕产妇死亡原因中,胎盘储留及宫缩乏力在整个项目周期中占产科出血病因构成比60%以上。2010年后因胎盘储留发生率下降,宫缩乏力超过胎盘储留成为引起产科出血死亡的主要原因。(4)2010-2014年住院分娩率97.56%,孕产妇总死亡率26.64/10万,家中分娩死亡率136.30/10万,住院分娩死亡率是14.69/10万。结论贵州省项目地区孕产妇死亡率从1999-2014年持续下降,产科出血和妊高征等可避免死因降低更明显。影响孕产妇死亡率的主要因素是住院分娩,因此应努力提高农村尤其是贵州省落后地区农村妇女的住院分娩率。Objective To evaluate the impact of Safe Motherhood Project on the maternal death in project counties in Guizhou Province. Methods Routinely reported data of maternal mortality and mortal death certificates in project counties in Guizhou Province were used to analyze the change of maternal death pattern. Results Since the implement of the Safe Motherhood Project, the hospital delivery rate in the project counties increased from 17.08% in 1999 to 98.48% in 2014. The maternal mortality dropped form 144.79/100,000 in 1999 to 29.44/100,000 in 2014.Hemorrhage, hypertensive disorders of pregnancy and amniotic fluid embolism had kept being the leading causes of maternal death. Since the hospital delivery rate was raised to 〉90% in 2010, the causes of maternal death had had important changes： proportions of maternal deaths due to postpartum hemorrhage and hypertensive disorders were decreased, and hepatic vein thrombosis and pulmonary thromboembolism got into the top five causes of maternal death. Retention of plaeenta and inertia of uterus had kept accounting for 〉60% of the causes of maternal hemorrhage. Since the incidence of retention of placenta decreased in 2010, inertia of uterus had been the leading cause of maternal hemorrhage. In 2010-2014, the hospital delivery rate was 97.56%.The overall maternal mortality ratio （MMR） was 26.64 deaths per 100,000 live births. The MMRs for home delivery and hospital delivery were respectively 136.30 and 14.69 deaths per 1000,000 live births. Conclusions The maternal mortality ratio kept decreasing from 1999 to 2014 in Safe Motherhood Project counties in Guizhou Province. The decline of deaths from avoidable causes such as hemorrhage and hypertensive disorders was more evident. The main influential factors of MMR was hospitalized delivery. More effort is needed to increase the hospital delivery rate in rural, particularly in poor rural areas in Guizhou.

关 键 词：“降低孕产妇死亡率和消除新生儿破伤风”项目 孕产妇 死亡率 死亡原因 

分 类 号：R714.66[医药卫生—妇产科学]