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目的:分析上海市1997～2006年因产后出血死亡产妇的情况和影响因素,为制定干预措施提供依据。方法:通过全市三级妇幼保健网收集孕产妇死亡个案资料,对每例死亡孕产妇个案进行现场调查,并每季度召开1次孕产妇死亡专家评审会,对死亡病例进行归类。结果:①上海市1997～2006年因产后出血死亡产妇80例,其中72例为外来产妇,8例为本市户籍产妇,外来产妇产后出血死亡率远远大于本地产妇。产后出血死亡居全市孕产妇死亡原因的首位。②外地产妇产后出血的首要原因为胎盘因素,占所有出血原因的29.6%,其次是子宫破裂;本市户籍产妇产后出血的首要原因是宫缩乏力。③死亡产妇中,外地产妇住院分娩率低,大部分在家分娩(74.6%),在途中和家中死亡的28例,占38.9%;本市产妇有1例在途中死亡。结论:家中分娩和非法接生是造成外来孕产妇产后出血死亡的主要原因。要进一步降低产后出血死亡率,除了提高产后出血处理能力外,还要提高外来孕产妇的住院分娩率。
Objective: To analyze the situation and influencing factors of maternal deaths from postpartum hemorrhage in Shanghai from 1997 to 2006, and provide the basis for the formulation of intervention measures. Methods: The data of maternal deaths were collected through the city’s three-level maternal and child health care network. On-site investigation was conducted on each case of pregnant women who died and one expert review meeting on maternal death was held every quarter to classify the deaths. Results: ①There were 80 maternal deaths in Shanghai from 1997 to 2006 due to postpartum hemorrhage, of which 72 were exogenous maternity and 8 were maternal immigrants. The mortality rate of postpartum hemorrhage among foreign maternal was far greater than that of local maternal. The death of postpartum hemorrhage ranks first in the cause of maternal death in the city. ② The main reason for maternal postpartum hemorrhage in the field is placenta, accounting for 29.6% of all bleeding causes, followed by rupture of the uterus. The most common cause of postpartum hemorrhage in this city is maternal uterine inertia. Among the dead mothers, foreign mothers in the field had a low hospital delivery rate, most of them delivered at home (74.6%), 28 died on the way and at home, accounting for 38.9%. One maternal death occurred on the way. Conclusion: Childbirth and illegal delivery at home are the main causes of postpartum hemorrhage among pregnant women. To further reduce postpartum hemorrhage mortality, in addition to improving the ability of postpartum hemorrhage, but also to increase the rate of foreign maternal hospital delivery.