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目的:分析导致孕产妇死亡的主要原因产科出血,提出有效降低因产科出血导致孕产妇死亡的发病率,从而降低青海省孕产妇死亡率的对策。方法:对青海省2004～2007年“三网”监测县死亡的82例孕产妇中的44例因产科出血死亡的病例进行分析。结果:(1)一般情况:文盲及小学以下文化程度31例,居住山区38例,孕次≥3次18例。(2)相关因素:①分娩地点:在家分娩12例,转诊途中分娩5例,住院分娩22例(除外5例未产)。②死亡地点:在家死亡14例,转诊途中6例,医院24例。③接受保健情况:未接受产前保健的8例,产检≥4次13例,④评审结果可避免死亡44例。(3)死因顺位:44例产科出血原因依次为胎盘滞留21例,宫缩乏力13例,子宫破裂3例,前置胎盘3例。结论:提高农村住院分娩率,加强基层产科建设,广泛开展健康教育。
OBJECTIVE: To analyze the main causes of maternal mortality in obstetric hemorrhage and to propose strategies to reduce the incidence of maternal mortality due to obstetric hemorrhage and to reduce the maternal mortality in Qinghai. Methods: Forty - four out of 82 pregnant women who died in the surveillance of “Three Networks” from 2004 to 2007 in Qinghai Province were analyzed for their death from obstetric hemorrhage. Results: (1) General situation: There are 31 cases of illiteracy and primary school education, 38 cases of living mountain area and 18 cases of pregnancy ≥ 3 times. (2) Relevant factors: ① place of delivery: 12 cases of childbirth at home, 5 cases of childbirth during referral and 22 cases of childbirth (except 5 cases not given birth). ② place of death: 14 cases of death at home, 6 cases of referral, 24 cases of hospital. ③ Acceptance of health care: 8 cases did not receive prenatal care, 13 cases were ≥4 times of birth examination, ④ The results of the assessment could avoid 44 cases of death. (3) The cause of death: 44 cases of obstetric hemorrhage followed by placenta retention in 21 cases, uterine inertia in 13 cases, 3 cases of uterine rupture, placenta previa in 3 cases. Conclusion: To improve the rate of hospital delivery in rural areas, strengthen the obstetrics and gynecology at grassroots level and carry out extensive health education.