Analysis of Maternal Death Causes in Huadu District, Guangzhou During 2000-2013

doi:10.3877/cma.j.issn.1673-5250.2014.01.018

Objective

To analyze the maternal death causes of the region and find out problems in maternal treatment process and management system in order to provide a scientific basis for the development of interventions to reduce maternal mortality.

Methods

Retrospectively analyze dates on annual maternal deaths information and assessment results in Huadu District, Guangzhou from 2000 to 2013.

Results

The number of live birth increased year by year in Huadu District, Guangzhou in 14 years. The total cases of maternal death is 65, and the average annual incremental rate is 10.58%. Maternal mortality of average household population and the whole population is 21.73/ 10⁵ and 38.45/ 10⁵ respectively. The maternal mortality rate decreased year by year in 14 years, especially the migrants maternal mortality rate reduced significantly. Direct obstetric causes of death is 64.62 %, indirect obstetric causes of death is 30.77% and unknown causes of death is 4.62%. The top five causes of maternal death are amniotic fluid embolism, postpartum hemorrhage, pregnancy with heart disease, hypertensive disorders in pregnancy and ectopic pregnancy.

Conclusions

The causes of maternal death showed a trend of diversification, changes in the ratio of mortality presented new challenges for us to explore new obstetric service model. Professional skills training and maternal health system are the guarantee for maternal and child's well-being.

Key words: Maternal mortality, Cause of death, Epidemiology, Intervention studies

图1 2000–2013年度活产数变化

Figure 1 The changes in the number of live birth in 2000-2013

图2 2000－2013年度孕产妇死亡率变化情况

Figure 2 The changes of maternal mortality in 2000-2013

表1 2000-2013年度广州花都区65例死亡孕产妇一般情况及就诊情况[n（%）]

Table 1 General conditions and treatment of maternal mortality of 65 cases in 2000-2013 in Huadu district, Guangzhou [n（%）]

项目	分类	构成比	项目	分类	构成比
户籍情况	广州市	21(32.31)	类别	产妇	48(73.85)
	非广州本省	4 (6.15)		孕妇	17(26.15)
	非本省	40(61.54)	文化程度	文盲	3 (4.62)
计划生育情况	计划内妊娠	24(36.92)		小学	22(33.85)
	计划外妊娠	40(61.54)		初中	25(38.46)
	不详	1 (1.54)		高中或中专	3 (4.62)
孕次	1次	24(36.92)		大专及以上	3 (4.62)
	2次	19(29.23)		不详	9(13.85)
	3次	10(15.38)	产妇分娩地点	家中或私人诊所	22(45.83)
	≥4次	9(13.85)		民营/社会医疗机构	1 (2.08)
	不详	3 (4.62)		一级医院	9(18.75)
产次	0次	12(18.46)		二级医院	15(31.25)
	1次	25(38.46)		三级医院	1 (2.08)
	2次	20(30.77)	首诊地点	私人诊所/卫生站	5 (7.69)
	≥3次	5 (7.69)		民营/社会医疗机构	5 (7.69)
	不详	3 (4.62)		一级医院	23(35.38)
初检孕周	12⁺⁶孕周以内	3 (4.62)		二级医院	29(44.62)
	13?28孕周	12(18.46)		三级医院	0 (0.00)
	28孕周以上	4 (6.15)		未就诊/就诊情况不详	3 (4.62)
	不详	46(70.77)	死亡地点	民营/社会医疗机构	1 (1.54)
产检次数	无产前检查或产前检查情况不详	36(55.38)		一级医院	12(18.46)
				二级医院	21(32.32)
	1?4次	20(30.77)		三级医院	20(30.77)
	≥5次	9(13.85)		途中/家中	11(16.92)

表1 2000-2013年度广州花都区65例死亡孕产妇一般情况及就诊情况[n（%）]

Table 1 General conditions and treatment of maternal mortality of 65 cases in 2000-2013 in Huadu district, Guangzhou [n（%）]

项目	分类	构成比	项目	分类	构成比
户籍情况	广州市	21(32.31)	类别	产妇	48(73.85)
	非广州本省	4 (6.15)		孕妇	17(26.15)
	非本省	40(61.54)	文化程度	文盲	3 (4.62)
计划生育情况	计划内妊娠	24(36.92)		小学	22(33.85)
	计划外妊娠	40(61.54)		初中	25(38.46)
	不详	1 (1.54)		高中或中专	3 (4.62)
孕次	1次	24(36.92)		大专及以上	3 (4.62)
	2次	19(29.23)		不详	9(13.85)
	3次	10(15.38)	产妇分娩地点	家中或私人诊所	22(45.83)
	≥4次	9(13.85)		民营/社会医疗机构	1 (2.08)
	不详	3 (4.62)		一级医院	9(18.75)
产次	0次	12(18.46)		二级医院	15(31.25)
	1次	25(38.46)		三级医院	1 (2.08)
	2次	20(30.77)	首诊地点	私人诊所/卫生站	5 (7.69)
	≥3次	5 (7.69)		民营/社会医疗机构	5 (7.69)
	不详	3 (4.62)		一级医院	23(35.38)
初检孕周	12⁺⁶孕周以内	3 (4.62)		二级医院	29(44.62)
	13?28孕周	12(18.46)		三级医院	0 (0.00)
	28孕周以上	4 (6.15)		未就诊/就诊情况不详	3 (4.62)
	不详	46(70.77)	死亡地点	民营/社会医疗机构	1 (1.54)
产检次数	无产前检查或产前检查情况不详	36(55.38)		一级医院	12(18.46)
				二级医院	21(32.32)
	1?4次	20(30.77)		三级医院	20(30.77)
	≥5次	9(13.85)		途中/家中	11(16.92)

表2 2000~ 2013年度孕产妇死亡原因顺位及构成比[n（%）]

Table 2 Causes of maternal mortality and overall proportions in 2000-2013[n（%）]

直接产科死因			间接产科死因			死因不明
顺位	死因	构成比	顺位	死因	构成比	顺位	死因	构成比
1	羊水栓塞	13(20.00)	1	妊娠合并心脏病	8(12.31)	1	死因不详	2(3.08)
2	产后出血	11(16.92)	2	重症肺炎	2 (3.08)	2	猝死	1(1.54)
3	妊娠期高血压疾病	7(10.77)	3	重症肝炎	2 (3.08)
4	异位妊娠	5 (7.69)	4	病毒性脑炎	1 (1.54)
4	子宫破裂	2 (3.08)	4	急性淋巴细胞性白血病	1 (1.54)
6	产褥感染	2 (3.08)	4	妊娠合并地中海贫血	1 (1.54)
7	胎盘早剥	1 (1.54)	4	血栓性血小板减少性紫癜	1 (1.54)
7	终止妊娠	1 (1.54)	4	Ⅱ型糖尿病，肾衰	1 (1.54)
			4	肝破裂	1 (1.54)
			4	脑梗塞，脑出血	1 (1.54)
			5	系统性红斑狼疮	1 (1.54)
	合计	42(64.62)		合计	20(30.76)		合计	3 (4.62)

表2 2000~ 2013年度孕产妇死亡原因顺位及构成比[n（%）]

Table 2 Causes of maternal mortality and overall proportions in 2000-2013[n（%）]

直接产科死因			间接产科死因			死因不明
顺位	死因	构成比	顺位	死因	构成比	顺位	死因	构成比
1	羊水栓塞	13(20.00)	1	妊娠合并心脏病	8(12.31)	1	死因不详	2(3.08)
2	产后出血	11(16.92)	2	重症肺炎	2 (3.08)	2	猝死	1(1.54)
3	妊娠期高血压疾病	7(10.77)	3	重症肝炎	2 (3.08)
4	异位妊娠	5 (7.69)	4	病毒性脑炎	1 (1.54)
4	子宫破裂	2 (3.08)	4	急性淋巴细胞性白血病	1 (1.54)
6	产褥感染	2 (3.08)	4	妊娠合并地中海贫血	1 (1.54)
7	胎盘早剥	1 (1.54)	4	血栓性血小板减少性紫癜	1 (1.54)
7	终止妊娠	1 (1.54)	4	Ⅱ型糖尿病，肾衰	1 (1.54)
			4	肝破裂	1 (1.54)
			4	脑梗塞，脑出血	1 (1.54)
			5	系统性红斑狼疮	1 (1.54)
	合计	42(64.62)		合计	20(30.76)		合计	3 (4.62)

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