目的 分析湖南省2011-2015年产科出血致孕产妇死亡的动态变化趋势,探讨其主要死因构成及相关影响因素,为今后湖南省预防产科出血致孕产妇死亡提供一定的理论依据. 方法 收集湖南省2011-2015年191例产科出血死亡孕产妇的监测资料及评审结果,采用描述性统计方法分析湖南省产科出血死亡孕产妇的死因构成及死亡特征,应用趋势性卡方检验分析湖南省2011-2015年产科出血孕产妇死亡率的变化趋势. 结果 1)2011-2015年湖南省孕产妇死亡率、产科出血孕产妇死亡率均呈下降趋势(P<0.05);2)产科出血致孕产妇死亡的原因中以宫缩乏力最为常见,占46.07%,其次为子宫破裂(12.04%)和前置胎盘(10.99%);3)产科出血死亡孕产妇产检大于等于5次者占56.02%,分娩和死亡地点在县级医院比例分别为38.74%和37.70%;4)评审结论表明产科出血孕产妇死亡病例中96.34%为可避免死亡. 结论 加强产科人员的专业知识技能培训,提高县乡级医疗机构孕产期保健服务质量是降低产科出血孕产妇死亡的有效措施.
Objective To analyze the dynamic changing trend,the main causes and influencing factors of maternal deaths from obstetric hemorrhage in Hunan Province during 2011-2015 so as to provide a theoretical basis for preventing maternal death from obstetric hemorrhage in future.Methods We collected the monitoring data and evaluation results regarding 191 cases of maternal deaths from obstetric hemorrhage in Hunan Province during 2011-2015,and then descriptive statistical methods were used to analyze the constituents of causes and characteristics of deaths from obstetric hemorrhage.Linear trend chi-square test was employed to analyze the changing tendency of maternal mortality rate from obstetric hemorrhage from 2011 to 2015.Results The total maternal mortality rate and the maternal mortality rate from obstetric hemorrhage in Hunan Province both showed a declining tendency from 2011 to 2015 (P<0.05).Uterine atony (46.07%) ranked as the first cause for obstetric hemorrhage,followed by uterine rupture (12.04%) and placenta previa (10.99%).Among the maternal deaths from obstetric hemorrhage,the proportions of the maternals receiving prenatal examination at least 5 times and having delivery place and death location in the county-level hospitals were 56.02%,38.74% and 37.70% respectively.Evaluation revealed that 96.34% of the maternal deaths from obstetric hemorrhage could be avoided.Conclusions Strengthening professional skill training in obstetric professionals and improving quality of maternal health care services in township medical institutions are effective measures to reduce maternal mortality from obstetric hemorrhage.