上海市2000-2009年孕产妇死亡情况分析
상해시2000-2009년잉산부사망정황분석
Analysis of maternal deaths in Shanghai from 2000 to 2009
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2011年 4期 244-249 ,共6页

    秦敏%朱丽萍%张蕾%杜莉%许厚琴

    진민%주려평%장뢰%두리%허후금

    产妇死亡率%死亡原因 產婦死亡率%死亡原因
    산부사망솔%사망원인
    Maternal mortality%Cause of death
    目的 通过对上海市孕产妇死亡资料的分析,了解孕产妇系统管理中的问题,为提出有效的干预措施降低孕产妇死亡率提供科学依据.方法 采用回顾性分析的方法,对上海市2000至2009年孕产妇死亡病例资料及评审结果、WHO十二格表分类进行分析.结果 (1)活产数变化:上海市活产总数从2000年的84 898例上升到2009年的187 335例,10年增加了120.7%.其中外地户籍来上海分娩者近10年有大幅度增长,已从2000年的26.5%上升到2009年的54.8%,期间增长了4.6倍.(2)孕产妇死亡率及其构成比:2000至2009年上海市活产数共1 279 010例,其中孕产妇死亡262例,死亡率为20.48/10万(262/1 279 010).上海市户籍者死亡率为8.09/10万(55/680 005);外地户籍者死亡率为34.56/10万(207/599 005).(3)不同广籍死亡率变化趋势:从2000年的21.2/10万降至2009年的9.61/10万.上海市户籍者孕产妇死亡率除2003至2004年外基本稳定在10.00/10万以下;外地户籍者孕产妇死亡率下降明显,2002年高达77.42/10万,而到了2009年已下降到11.69/10万.(4)孕产妇死因构成比及顺位:262例孕产妇死亡前5位的死因顺位依次为产科出血(69例,26.3%)、妊娠期高血压疾病(27例,10.3%)、妊娠合并心脏疾病(24例,9.2%)、妊娠合并肝脏疾病(17例,6.5%)、羊水栓塞和异位妊娠(均为15例,5.7%).(5)2000至2009年前后两个5年孕产妇主要死因变化:上海市户籍者的异位妊娠、妊娠期高血压疾病和妊娠合并心脏疾病的死因变化较大,其中异位妊娠死亡率从第一个5年的1.36/10万下降到第二个5年的0.26/10万;妊娠合并心脏疾病从第一个5年的1.36/10万下降到第二个5年的0.52/10万;妊娠期高血压疾病从第一个5年的0上升到第二个5年的0.78/10万.外地户籍者孕产妇的产科出血、异位妊娠、妊娠期高血压疾病死亡率下降显著,作为首位死因的产科出血从第一个5年的21.85/10万下降到第二个5年的5.47/10万;异位妊娠从第一个5年的4.37/10万下降到第二个5年的0.68/10万;而妊娠期高血压疾病从第一个5年的6.87/10万下降到第二个5年的2.96/10万.(6)直接产科原因与间接产科原因的死亡:262例死亡孕产妇中,直接产科原因导致的死亡141例(53.8%);而间接产科原因导致的死亡121例(46.2%).(7)产科出血死亡率的变化:2000至2009年的10年间,上海市孕产妇产科出血死亡率呈逐年下降趋势,从2000年的10.6/10万下降至2009年的1.7/10万.(8)孕产妇死亡病例的评审结果:262例死亡孕产妇经上海市级专家评审后结果分为3类,Ⅰ类(可避免死亡)41例(15.6%),Ⅱ类(创造条件可以避免死亡)66例(25.2%),Ⅲ类(不可避免死亡)155例(59.2%).55例上海市户籍死亡孕产妇中,Ⅰ类17例(30.9%),Ⅱ类14例(25.5%),Ⅲ类24例(43.6%);207例外地户籍死亡孕产妇中,Ⅰ类24例(11.6%),Ⅱ类52例(25.1%),Ⅲ类131例(63.3%).(9)WHO十二格表分类:从死亡孕产妇的知识技能、态度、资源和管理方面分析上海市户籍和外地户籍孕产妇死亡原因的影响因素显示,上海市户籍死亡者中以医疗保健机构的知识技能问题占主要原因(80.0%);外地户籍死亡者中以个人家庭的知识技能和态度为主要原因,分别为54.1%和40.1%.结论 (1)近10年上海市孕产妇死亡率(尤其是外地户籍孕产妇死亡率)逐年显著下降,结果提示上海市对孕产妇的系统管理措施有效.(2)产科出血虽然跃居10年孕产妇死因的首位,但呈显著下降的趋势;30%～40%的孕产妇死亡可创造条件加以避免.(3)但随着孕产妇死因构成比的变化及服务需求的提高,探索新的服务与管理模式以保障母婴安康更显得十分必要.
    목적 통과대상해시잉산부사망자료적분석,료해잉산부계통관리중적문제,위제출유효적간예조시강저잉산부사망솔제공과학의거.방법 채용회고성분석적방법,대상해시2000지2009년잉산부사망병례자료급평심결과、WHO십이격표분류진행분석.결과 (1)활산수변화:상해시활산총수종2000년적84 898례상승도2009년적187 335례,10년증가료120.7%.기중외지호적래상해분면자근10년유대폭도증장,이종2000년적26.5%상승도2009년적54.8%,기간증장료4.6배.(2)잉산부사망솔급기구성비:2000지2009년상해시활산수공1 279 010례,기중잉산부사망262례,사망솔위20.48/10만(262/1 279 010).상해시호적자사망솔위8.09/10만(55/680 005);외지호적자사망솔위34.56/10만(207/599 005).(3)불동엄적사망솔변화추세:종2000년적21.2/10만강지2009년적9.61/10만.상해시호적자잉산부사망솔제2003지2004년외기본은정재10.00/10만이하;외지호적자잉산부사망솔하강명현,2002년고체77.42/10만,이도료2009년이하강도11.69/10만.(4)잉산부사인구성비급순위:262례잉산부사망전5위적사인순위의차위산과출혈(69례,26.3%)、임신기고혈압질병(27례,10.3%)、임신합병심장질병(24례,9.2%)、임신합병간장질병(17례,6.5%)、양수전새화이위임신(균위15례,5.7%).(5)2000지2009년전후량개5년잉산부주요사인변화:상해시호적자적이위임신、임신기고혈압질병화임신합병심장질병적사인변화교대,기중이위임신사망솔종제일개5년적1.36/10만하강도제이개5년적0.26/10만;임신합병심장질병종제일개5년적1.36/10만하강도제이개5년적0.52/10만;임신기고혈압질병종제일개5년적0상승도제이개5년적0.78/10만.외지호적자잉산부적산과출혈、이위임신、임신기고혈압질병사망솔하강현저,작위수위사인적산과출혈종제일개5년적21.85/10만하강도제이개5년적5.47/10만;이위임신종제일개5년적4.37/10만하강도제이개5년적0.68/10만;이임신기고혈압질병종제일개5년적6.87/10만하강도제이개5년적2.96/10만.(6)직접산과원인여간접산과원인적사망:262례사망잉산부중,직접산과원인도치적사망141례(53.8%);이간접산과원인도치적사망121례(46.2%).(7)산과출혈사망솔적변화:2000지2009년적10년간,상해시잉산부산과출혈사망솔정축년하강추세,종2000년적10.6/10만하강지2009년적1.7/10만.(8)잉산부사망병례적평심결과:262례사망잉산부경상해시급전가평심후결과분위3류,Ⅰ류(가피면사망)41례(15.6%),Ⅱ류(창조조건가이피면사망)66례(25.2%),Ⅲ류(불가피면사망)155례(59.2%).55례상해시호적사망잉산부중,Ⅰ류17례(30.9%),Ⅱ류14례(25.5%),Ⅲ류24례(43.6%);207예외지호적사망잉산부중,Ⅰ류24례(11.6%),Ⅱ류52례(25.1%),Ⅲ류131례(63.3%).(9)WHO십이격표분류:종사망잉산부적지식기능、태도、자원화관리방면분석상해시호적화외지호적잉산부사망원인적영향인소현시,상해시호적사망자중이의료보건궤구적지식기능문제점주요원인(80.0%);외지호적사망자중이개인가정적지식기능화태도위주요원인,분별위54.1%화40.1%.결론 (1)근10년상해시잉산부사망솔(우기시외지호적잉산부사망솔)축년현저하강,결과제시상해시대잉산부적계통관리조시유효.(2)산과출혈수연약거10년잉산부사인적수위,단정현저하강적추세;30%～40%적잉산부사망가창조조건가이피면.(3)단수착잉산부사인구성비적변화급복무수구적제고,탐색신적복무여관리모식이보장모영안강경현득십분필요.
    Objectives To find problems in the systematic management of maternal health and to provide evidence for developing effective interventions to reduce maternal mortality in Shanghai. Methods Every maternal death from 2000 to 2009 was audited by experts and relevant informations were collected and analyzed retrospectively. Results ( 1 ) Number of live births. The number of live births in Shanghai rised from 84 898 in 2000 to 187 335 in 2009, which increased by 120. 7%. Notably, the number of live births of migrating people increased 4. 6 times. In 2000, it took up 25.5% and in 2009, it rose to 54. 8%. ( 2 )Maternal mortality ratio (MMR) and its composition. The total live births from 2000 to 2009 was 1 279 010,among which there were 262 maternal deaths, with average maternal mortality of 20. 48 per 100 000 live birth (262/1 279 010). For Shanghai residents, the MMR was 8.09 per 100 000 live births (55/680 005 ),while the MMR of migrating people was 34. 56 per 100 000 live births ( 207/599 005 ). ( 3 ) Trends of MMR. The MMR declined from 21.2 per 100 000 live births in 2000 to 9.61 per 100 000 live births in 2009. The MMR of Shanghai residents maintained below 10 per 100 000 live births with exception of year 2003 and 2004. The MMR of migrating people declined sharply. In 2002 it was 77.42 per 100 000 live births, and in 2009 it decreased to 11. 69 per 100 000 live births. (4)The composition of causes of maternal deaths and rank order. The top 5 causes of deaths were obstetric hemorrhage (69 cases, 26. 3% of the total deaths), pregnancy induced hypertension (27 cases, 10. 3% of the total deaths), heart diseases (24 cases,9. 2% of the total deaths), liver diseases ( 17 cases, 6. 5% of the total deaths), amniotic fluid embolism and ectopic pregnancy ( 15 cases respectively, 5.7% of the total deaths). ( 5 ) The changes of causes between the first 5 years and the latter 5 years. The MMR of ectopic pregnancy, heart diseases and pregnancy induced hypertension changed significantly in Shanghai residents. The MMR of ectopic pregnancy decreased from 1.36 per 100 000 live births in the first 5 years to 0. 26 per 100 000 live births in the latter 5 years. The MMR of heart diseases decreased from 1.36 per 100 000 live births to 0. 52 per 100 000 live births. While the MMR of pregnancy induced hypertension increased from 0 to 0. 78 per 100 000 live births. For migrating population, the MMR of obstetric hemorrhage, ectopic pregnancy and pregnancy induced pregnancy deceased significantly. As the primary cause, the MMR of obstetric hemorrhage deceased from 21.85 per 100 000 live births in the first 5 years to 5.47 per 100 000 live births in the second 5 years. The MMR of ectopic pregnancy decreased from 4. 37 per 100 000 live births to 0. 68 per 100 000 live births. And the MMR of pregnancy induced hypertension decreased from 6. 87 per 100 000 live births to 2. 96 per 100 000 live births.(6) Direct obstetric causes and indirect obstetric causes of maternal deaths. Among the 262 deaths,141 cases (53. 8% ) were due to Direct obstetric causes and 121 (46. 2% ) were due to indirect obstetric causes. (7)The trend of MMR of obstetric hemorrhage. The MMR of obstetric hemorrhage declined from 10. 6 per 100 000 live births in 2000 to 1.7 per 100 000 live births in 2009. ( 8 ) The results of maternal death audit. The results of maternal death audit were classified into 3 categories: 41 cases ( 15.6% )belonged to the first category, i. e, avoidable deaths; 66 cases (25.2%) belonged to the second category,i. e, avoidable when creating some conditions; and 155 cases (59. 2% ) belonged to the third category,which means not avoidable. Among 55 deaths of Shanghai residents, 17 cases (30. 9% ) belonged to the first category, 14 cases (25.5%) belonged to the second, and 24 cases (43.6%) belonged to the third category. Among 207 deaths of migrating population, 24 cases (11.6%) belonged to the first category,52 cases (25. 1% ) belonged to the second, and 131 cases (63.3%) belonged to the third category. (9)WHO twelve-grid classification of maternal deaths. The factors, including attitude, knowledge and skills, resources and management of the dead people and their families, the medical institutes and social supportive departments were integrated and analyzed. It showed that the main reason of maternal deaths of Shanghai residents was poor knowledge and skills of medical staffs, accounting for 80. 0% of the deaths. While the main reasons of maternal deaths of migrating people were poor knowledge and skills, inappropriate attitude of the dead people and their families, which took up 54. 1% and 40. 1% respectively. Conclusions The MMR in Shanghai declined continuously from 2000 to 2009, especially for migrating population which reflected the interventions of maternal management in Shanghai were effective. Though obstetric hemorrhage was the first top cause of maternal death during past 10 years, it declined Sharply. 30% to 40% maternal deaths were avoidable if some conditions were created. However, in order to adapt the changes of main causes of maternal deaths and accomplish increasing service requirements, it is necessary to develop new service and management mode.
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