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目的:寻找影响孕产妇死亡率下降的相关因素,总结推广有效的保障母婴安全的干预措施。方法:采用回顾性分析的方法,对上海市近5年孕产妇死亡的所有个案及评审资料进行分析。结果:①上海市活产数从2005年的125 130例上升到2009年的187 335例,增加了49.71%,外来流动孕产妇活产数比例从2005年的51.12%上升到2009年的54.8%。②5年中孕产妇死亡134例,死亡率16.28/10万(134/823 144);其中本地户籍者死亡25例,死亡率为7.10/10万;外地户籍者死亡109例,死亡率为23.15/10万。全市孕产妇死亡率从2005年的25.57/10万降至2009年的9.61/10万,下降62.42%,其中外来孕产妇死亡率从2005年的48.46/10万下降到2009年的11.69/10万,下降75.88%。③5年中孕产妇主要死因顺位为:产科出血(21.64%)、妊娠期高血压疾病(11.90%)、心脏疾病(11.19%)、肝脏疾病(7.46%)、羊水栓塞(7.46%)。上海本市户籍者主要死因顺位分别为:产科出血(20.00%)、肝脏疾病(16.00%)、妊娠期高血压疾病(12.00%)、心脏疾病(8.00%)和脑血管意外(6.00%);外地户籍孕产妇死因顺位依次为:产科出血(22.02%)、妊娠期高血压疾病(11.93%)、心脏疾病(11.93%)、羊水栓塞(8.26%)和子宫破裂(6.42%)。④5年中直接产科原因死亡者66例(49.25%),构成比从2005年的61.11%下降到2009年的27.78%。⑤在2004～2007年上海市采取了一系列干预措施来保障母婴安全,使上海市孕产妇死亡率显著下降。出血死亡专率从2005年的6.39/10万下降到2009年的1.08/10万。外来孕产妇出血、妊娠高血压疾病死亡率分别从12.51/10万和4.69/10万下降到0.97/10万和1.95/10万。外来孕产妇产科出血、异位妊娠,妊娠期高血压疾病死亡率从前5年的21.85/10万、4.37/10万和6.87/10万下降到到后5年的5.47/10万、0.68/10万和2.96/10万。结论:近5年上海市孕产妇死亡率(尤其是外来孕产妇死亡率)显著下降,提示了一系列干预措施的有效性。
OBJECTIVE: To find out the relevant factors that affect the decline of maternal mortality and summarize the promotion of effective interventions to ensure the safety of mother and baby. Methods: A retrospective analysis of all cases of past maternal deaths in Shanghai in the past five years and the assessment data were analyzed. Results: ① The number of live births in Shanghai rose from 125 130 in 2005 to 187 335 in 2009, an increase of 49.71%. The proportion of live-born migrant women rose from 51.12% in 2005 to 54.8% in 2009 . (2) 134 maternal deaths occurred in 5 years with a mortality rate of 16.28 / 100000 (134/823 144). Among them 25 were local resident deaths with a death rate of 7.10 / 100 000; 109 were dead in rural areas with a death rate of 23.15 / 100,000. The city’s maternal mortality rate dropped from 25.57 / 100,000 in 2005 to 9.61 / 100,000 in 2009, a decrease of 62.42%. The maternal mortality rate dropped from 48.46 / 100,000 in 2005 to 11.69 / 100,000 in 2009 , Down 75.88%. The main cause of maternal death in 5 years was obstetric bleeding (21.64%), gestational hypertension (11.90%), heart disease (11.19%), liver disease (7.46%) and amniotic fluid embolism (7.46%). The main cause of death of Shanghai residents was obstetric bleeding (20.00%), liver disease (16.00%), gestational hypertension (12.00%), heart disease (8.00%) and cerebrovascular accident (6.00% (22.02%), hypertensive disorder of pregnancy (11.93%), heart disease (11.93%), amniotic fluid embolism (8.26%) and uterine rupture (6.42%). (4) 66 cases (49.25%) died of direct obstetric reasons in 5 years, the proportion decreased from 61.11% in 2005 to 27.78% in 2009. ⑤ In 2004-2007, Shanghai adopted a series of interventions to ensure the safety of mother and baby and significantly reduce the maternal mortality rate in Shanghai. The proportion of bleeding deaths dropped from 6.39 / 100,000 in 2005 to 1.08 / 100,000 in 2009. The death rates of external maternal bleeding and pregnancy-induced hypertension were decreased from 12.51 / 100 000 and 4.69 / 100 000 to 0.97 / 100 000 and 1.95 / 100 000 respectively. The death rate of external maternal obstetric hemorrhage, ectopic pregnancy and gestational hypertension dropped from 21.85 / 100000, 4.37 / 100000 and 6.87 / 100000 in the previous 5 years to 5.47 / 100,000 in the next 5 years, 0.68 / 10 Million and 2.96 / 100,000. Conclusion: The maternal mortality rate in Shanghai in recent 5 years (especially that of maternal mortality in foreign countries) has dropped significantly, suggesting the effectiveness of a series of interventions.