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目的千年目标已逼近,为实现千年目标之五(MDG5)采取迅速快捷行动,制定降低孕产妇死亡率的有效干预措施。方法对2006-2009年云南省孕产妇死亡监测及评审资料进行回顾性分析,采用SPSS15统计软件包进行处理。结果 4年间孕产妇死亡率呈逐年下降趋势,从2006年的64.0/10万下降到2009年的41.5/10万。孕产妇死因构成:直接产科死亡原因占72.7%,以产科出血高居首位,占49.9%,产后子宫收缩乏力及胎盘滞留是产科出血的主要原因,分别占33.7%及30.1%。死因顺位依次为:产科出血、合并内科疾病、羊水栓塞、妊娠期高血压疾病及产褥感染。影响孕产妇死亡的主要因素:①交通、经济、文化等的滞后导致孕妇不能住院分娩;②孕期保健服务质量较低,高危孕妇得不到及时筛查,或筛查出的高危孕妇得不到规范的管理及适时转诊;③县、乡两级产科人员处理产科急危重症能力偏低。结论加强孕期保健服务、提高住院分娩率及加大对县、乡两级产科人员的业务培训是加快降低孕产妇死亡率的关键;对因交通因素导致住院分娩确有困难的边远地区,加强对村医的产科适宜技术培训,切实保证边远少数民族地区无法住院分娩的产妇分娩安全,是降低孕产妇死亡率不容忽视的问题。
The Millennium Development Goals have been approached with swift and quick action to achieve MDG5 and effective interventions to reduce maternal mortality. Methods The data of maternal mortality monitoring and assessment in Yunnan from 2006 to 2009 were retrospectively analyzed and processed with SPSS15 statistical package. Results The maternal mortality rate showed a downward trend year by year in four years, from 64.0 / 100000 in 2006 to 41.5 / 100000 in 2009. The causes of maternal death: direct obstetric death accounted for 72.7%, obstetric bleeding topped 49.9%, postpartum uterine atony and placenta accreta was the main cause of obstetric hemorrhage, accounting for 33.7% and 30.1%. The order of the cause of death was obstetric bleeding, combined medical diseases, amniotic fluid embolism, hypertensive disorder of pregnancy and puerperal infection. The main factors affecting maternal mortality are: (1) delays in transportation, economy and culture lead to the inability of pregnant women to hospitalize for childbirth; (2) the quality of health care services during pregnancy is low, high-risk pregnant women are not screened in time or the high-risk pregnant women screened out are not available Standardized management and timely referral; ③ county and township obstetrics and gynecology staff to deal with obstetric emergency critical ability is low. Conclusion Strengthening the services for pregnant women during pregnancy, increasing the rate of hospital delivery and increasing the operational training of obstetricians at the county and township levels is the key to speeding up the reduction of maternal mortality. In the remote areas where there are indeed difficulties in hospital delivery due to traffic factors, Appropriate technical training for village doctors in obstetrics should be implemented to effectively ensure the safe delivery of mothers who can not be hospitalized for childbirth in remote ethnic minority areas. This is a problem that can not be ignored in reducing maternal mortality.