上海市危重孕产妇会诊抢救中心(仁济医院)12年孕产妇死亡病例分析  

Analysis of maternal deaths in Shanghai MNM Consultation and Rescue Center(Renji Hospital) in 12 years

作　　者：冯蜀欢 缪慧娴 吕鑫 汪川[1] 林建华[1] FENG Shu-huan;MIAO Hui-xian;LYU Xin;WANG Chuan;LIN Jian-hua(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海200127

出　　处：《中国实用妇科与产科杂志》2020年第10期976-981,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家科技部支撑课题(2014BAI05B05)。

摘　　要：目的通过分析上海市危重孕产妇会诊抢救中心(仁济医院)12年孕产妇死亡病例的临床资料,总结危重孕产妇的诊治措施。方法对设立在上海交通大学医学院附属仁济医院的上海市危重孕产妇会诊抢救中心2008年1月1日至2019年12月31日收治的危重孕产妇中的35例死亡病例进行回顾性分析。病例由仁济医院门急诊直接收入或由其他医疗机构通过三级妇幼保健网转入。结果(1)35例死亡病例中上海市户籍6例(17.14%)、外地常住人口10例(28.57%)、外地直接来沪就医19例(54.29%)。孕前对自身健康状况未评估者22例(62.86%)、已知妊娠风险但要求继续妊娠者13例(37.14%)。(2)死亡病因前5位依次为:妊娠合并心脏病(13例,37.14%)、妊娠合并中枢神经系统疾病(8例,22.86%)、妊娠合并重症肺炎(4例,11.43%)、妊娠合并免疫系统疾病(4例,11.43%)、妊娠期急性脂肪肝(2例,5.71%)。(3)围产儿结局:宫内妊娠34例(1例异位妊娠),其中活产18例(52.94%)[早产15例(83.33%)、足月产3例(16.67%)]、围产儿死亡16例(47.06%)。新生儿窒息10例,均抢救成功。结论仁济医院12年死亡病例死亡原因以严重的内外科合并症为主。针对危重乃至濒死的孕产妇抢救,需要完善的孕产妇孕期保健制度、内外科疾病诊疗的高水平及多学科联合诊治模式,但加强孕前和孕早期优生检查和健康状况的评估更为重要。提高产科医生对危重因素的早期识别、及时干预可减少危重孕产妇死亡率,提高其生存率。Objective To summarize diagnosis and treatment measures of maternal near miss(MNM) by analyzing the the clinical data of maternal deaths in Shanghai Consultation and Rescue Center(Renji Hospital)in 12 years.Methods A retrospective analysis was made on 35 cases of maternal deaths from January 1 st,2008 to December 31 th,2019 in Shanghai MNM Consultation and Rescue Center settled in Renji Hospital.The cases were directly received from outpatient and emergency department of Renji Hospital or transferred to the center by other medical institutions through the three-level network.Results(1) Among the 35 cases of death,6 cases(17.14%) were registered in Shanghai,10 cases(28.57%) were permanent residents in other cities,and 19 cases(54.29%) came directly to Shanghai for treatment.Twenty-two(62.86%) of them had no assessment of their health status before pregnancy,while 13(37.14%) of them refused to terminate pregnancy because of their known serious diseases.(2) The top five causes of death were:pregnancy with cardiovascular diseases(13 cases,37.14%),pregnancy with central nervous system diseases(8 cases,22.86%),pregnancy with severe pneumonia(4 cases,11.43%),pregnancy with immune system diseases(4 cases,11.43%),acute fatty liver during pregnancy(2 cases,5.71%).(3)There were 34 cases of intrauterine pregnancy(one case of ectopic pregnancy),18 cases of live birth(52.94%) [15 cases of premature birth(83.33%),3 cases of full-term birth(16.67%)],16 cases of perinatal deaths(47.06%),and 10 cases of neonatal asphyxia,which were all rescued sucessfully.Conclusion The major causes of death in12 years in Shanghai Maternal Near Miss Consultation and Rescue Center of Renji Hospital are serious medical and surgery complications.In order to rescue the MNM,it is necessary to improve the maternal health care system during pregnancy,the high level of diagnosis and treatment of internal medical and surgical diseases and the multi-disciplinary joint diagnosis and treatment mode,but it is more important to strengthen the prepregnancy and e

关 键 词：危重孕产妇 死亡病因 高危因素 

分 类 号：R714.2[医药卫生—妇产科学]