2010-2019年北京市孕产妇死亡率及死因分析  

Study on cause and rate of maternal deaths in Beijing,2010-2019

作　　者：杨惠娟[1] 潘迎[1] 于莹[1] 陈正超 刘凯波[1] YANG Hui-juan;PAN Ying;YU Ying;CHEN Zheng-chao;LIU Kai-bo(Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026 China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院,北京100026

出　　处：《首都公共卫生》2020年第5期237-241,共5页Capital Journal of Public Health

基　　金：北京市高危孕产妇管理策略研究与评估(编号:首发2018-2-2111)。

摘　　要：目的通过分析北京市孕产妇死亡率及死亡原因变化趋势,以及二孩政策调整对生育的影响,为进一步降低孕产妇死亡率提供依据。方法收集整理2010-2019年北京市孕产妇死亡病例及评审资料,分析孕产妇死亡率变化、死亡原因顺位、死亡评审结果及相关影响因素。结果2010-2019年北京市常住人口孕产妇死亡率呈波动下降趋势,2019年死亡率为4.12/10万,比2010年的13.81/10万下降了70.16%,平均年降幅7.79%。非本市户籍孕产妇死亡率年降幅(13.52%)高于本市户籍(3.24%),差异有统计学意义(Z=-2.113,P=0.035)。2010-2019年北京市非直接产科因素死亡占62.05%(121/195),死亡原因顺位前五位依次为妊娠合并心脏病、产科出血、羊水栓塞、肺栓塞和异位妊娠,2015年后北京市孕产妇死因多样化,猝死、肿瘤等疾病进入孕产妇死亡原因前五位,其他包括病毒性肺炎、肺动脉高压、自身免疫性疾病、癫痫等非常见因素死亡比例达到19.05%。高龄、经产孕产妇占29.23%(57/195)和45.64%(89/195),2015年后高龄、经产孕产妇死亡比例增加。死亡孕产妇中高危孕妇占77.95%(152/195),其中高风险占24.10%(47/195),较高风险占18.46%(36/195)。死亡时段:孕期死亡占34.36%(67/195),产时死亡3.08%(6/195),产后>24 h死亡占44.62%(87/195),前后五年比较差异无统计学意义。结论2010-2019年北京市孕产妇死亡率呈波动下降,降幅明显,2016年“全面两孩”政策调整致高龄、高危孕产妇增加,死亡原因多样化,还需进一步加强政策支持并优化多学科、全孕期精细管理,以保障母儿安全。Objective This study intended to figure out the changing trends of Maternal Mortality Ratio(MMR)and its cause of death from 2010 to 2019 in Beijing and provide basis for cutting down the MMR.The impaction of the two-child policy on the people’s fertility was also investigated.Methods The information of the material mortality cases in Beijing(from 2010 to 2019)was collected firstly,following by the investigation on changing trends of MMR,rank of the cause of death,audit of the death,and the features linking to the MMR.Results With average annual decrease of 7.79%,the overall MMR among Beijing residents dropped from 13.81 per 100000 live births in 2010 to 4.12 per 1000001ive births in 2019,which resulted in 70.16%decline from 2010 to 2019.Among these resident MMR cases,the decline rate of MMR for the migrating people(13.52%)was higher than that for the registered people in Beijing(3.24%)with statistical significant(Z=-2.113,P=0.035).From 2010 to 2019,the indirect obstetric factors accounted for 62.05%(121/195)death cases with top five causes of death were pregnancy complicated with heart disease,hemorrhage,amniotic fluid embolism,pulmonary embolism and ectopic pregnancy.However,the reason for maternal death become more complicated after 2015;Thus,the sudden death and tumor were listed in the top five causes of maternal death,and the causing factors including viral pneumonia,pulmonary hypertension,autoimmune diseases,epilepsy and other unusual indirect factors accounted 19.05%of total cases.Besides,the women with advanced maternal age and multipara pregnant accounted for 29.23%(57/195)and 45.64%(89/195)respectively with increasing trends for these women after 2015.Among all cases,the women with high risk factors accounted for 77.95%(152/195)with 24.10%(47/195)of the higher-risk women and 18.46(36/196)of the high-risk women.In term of the death period of the MMR,the deaths during pregnancy was 34.36%(67/195),the intrapartum maternal deaths was 3.08%(6/195),and the proportion of postpartum deaths after 24 hours was

关 键 词：孕产妇死亡率 死亡原因 直接产科因素死亡 非直接产科因素死亡 生育政策 

分 类 号：R714[医药卫生—妇产科学]