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目的:分析湖北省孕产妇死亡状况、孕产妇死亡率、主要死亡原因及相关因素。方法:采用流行病学回顾性研究方法,对1998~2001年各市、县(区)妇幼保健机构上报的737份孕产妇死亡个案卡、相关的个案调查报告以及全省孕产妇死亡监测报表进行分析。结果:4年平均孕产妇死亡率为48.76/10万。前5位死亡原因依次为:产科出血、妊高征、羊水栓塞、妊娠合并心脏病、产褥感染。其中产科出血占54.3%。影响孕产妇死亡率的主要因素单因素非条件Logistic回归分析显示,计划内比计划外直接产科原因死亡的几率小,孕产妇从分娩到死亡时间越短越是直接产科原因导致的死亡。旧法接生、生育次数多、接生人员技术水平差、怀孕次数多、人流引产次数多、居住在边远贫困地区、分娩地点医疗水平差、经济水平差、年龄大都是直接产科原因死亡的促进因素。737例死亡孕产妇做过产前检查的占76.0%,产检次数大于5次的只有22%。分娩地点与死亡地点在家中或转诊途中的分别为40.4%、41.7%,非医务人员接生的占20.5%。结论:湖北省孕产妇死亡率略低于全国的平均水平;主要死因为产科出血、妊高征、羊水栓塞、妊娠合并心脏病、产褥感染。需要进一步提高产前检查质量和数量,加强孕产妇保健系统管理,提高住院分娩率,加强高危孕产妇管理和危急重症的救治,可进一步降低湖北省孕产妇死亡率。
Objective: To analyze the status of maternal mortality, maternal mortality, the main causes of death and related factors in Hubei Province. Methods: An epidemiological retrospective study was conducted to analyze 737 cases of maternal deaths reported by MCH institutions in cities and counties (districts) from 1998 to 2001, the related case investigation reports and the maternal death monitoring reports of the province . Results: The average 4-year maternal mortality rate was 48.76 / 100000. The top five causes of death were as follows: obstetric hemorrhage, PIH, amniotic fluid embolism, pregnancy complicated with heart disease, puerperal infection. Obstetrical bleeding accounted for 54.3%. The main factors affecting maternal mortality Single-factor non-conditional Logistic regression analysis showed that the planned death rate was less than that of direct obstetric reasons. The shorter maternal birth to death time was the direct obstetric cause of death. The old method of birth, the number of births, the poor technical level of delivery personnel, the number of pregnancies, abortion more people live in remote poverty-stricken areas, poor medical level at the place of delivery, poor economic status, age are mostly direct cause of obstetric causes of death. Of the 737 deaths, maternal prenatal tests accounted for 76.0% of all deaths and only 22% had more than 5 births. The place of birth and the place of death were 40.4% and 41.7% respectively at home or on the way of referral, and non-medical staff took up 20.5%. Conclusion: The maternal mortality rate in Hubei Province is slightly lower than the national average. The main causes of death are obstetric hemorrhage, pregnancy induced hypertension, amniotic fluid embolism, pregnancy complicated with heart disease and puerperal infection. Need to further improve the quality and quantity of prenatal care, strengthen maternal health care system management, improve hospital delivery rate, strengthen the management of high-risk maternal and critically ill treatment, can further reduce the maternal mortality in Hubei Province.