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目的分析2009-2011年湖南省计划外生育孕产妇死亡相关特征,寻找减少计划外生育孕产妇死亡的可控因素,为制定计划外生育人群系统保健工作策略及政策提供理论依据。方法通过湖南省三级妇幼保健网络收集湖南省2009-2011年的孕产妇死亡资料共572例。依据计划生育情况,将其中有记录569例孕产妇死亡个案分为计划生育内、外组,分析指标包括:孕产妇的人口社会学因素、孕期保健相关因素、分娩相关特征、死亡相关特征。结果计划外生育组与计划内生育组组间比较:计划外生育组孕产妇死亡中高龄(35岁及以上)和低龄(小于20岁)构成比显著增高(χ2=78.828,P=0.000);妊娠次数(χ2=60.319,P=0.000)和分娩次数明显增多(χ2=56.887,P=0.000);产检次数明显减少,尤其是孕期从未做过产前检查者明显增加(χ2=43.793,P=0.000);分娩地点级别低,尤其是在家中及其他非法接生机构分娩者增多(χ2=29.351,P=0.000);计划外组剖宫产终止妊娠者明显减少(χ2=16.624,P=0.000);死于产科出血等直接产科原因者明显增多(χ2=23.096,P=0.000);可避免死亡构成比明显增多(χ2=13.735,P=0.001)。二组间死亡孕产妇的城乡分布、家庭年人均收入、死亡地点分布等构成比差异无统计学意义(P>0.05)。结论计划外生育死亡孕产妇特点是妊娠和分娩次数多、高龄或低龄妊娠、孕产期服务较差,产检次数少、分娩地点级别较低、产科出血等直接产科死因及可避免死亡构成比高。
Objective To analyze the related characteristics of unplanted maternal deaths in Hunan Province from 2009 to 2011 and find out the controllable factors to reduce the unplanned maternal deaths and provide theoretical basis for formulating systematic health care strategies and policies for unplanned people. Methods A total of 572 maternal death data were collected from 2009-2011 in Hunan Province through the three-level maternal and child health care network in Hunan Province. Based on the family planning situation, 569 cases of maternal deaths were recorded as internal and external groups of family planning. The analysis indexes included the socio-demographic factors of maternal population, health-related factors during pregnancy, characteristics related to childbirth and characteristics related to death. Results Comparison between the unplanned and unplanned fertility groups: The proportions of maternal death (35 and over) and younger (less than 20) in unplanned fertility group were significantly higher (χ2 = 78.828, P = 0.000); The number of pregnancy (χ2 = 60.319, P = 0.000) and the number of childbirth significantly increased (χ2 = 56.887, P = 0.000). The number of births was significantly decreased, especially during pregnancy. = Χ2 = 29.351, P = 0.000). The number of cesarean section termination of pregnancy in the unplanned group was significantly lower (χ2 = 16.624, P = 0.000), especially in those who delivered at home and other illegal delivery institutions. ); Those who died of obstetric hemorrhage and other obstetric reasons were significantly increased (χ2 = 23.096, P = 0.000); avoidable death ratio was significantly increased (χ2 = 13.735, P = 0.001). There was no significant difference in the proportions of the urban-rural distribution, the annual per-capita income and the distribution of death among the two groups of maternal deaths (P> 0.05). Conclusions Unplanned maternal deaths are characterized by multiple pregnancies and childbirths, older or younger pregnancies, poorer services during pregnancy, less number of births, lower place of delivery, direct obstetric causes of obstetric hemorrhage, and high avoidable deaths .