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目的评价“降低孕产妇死亡率和消除新生儿破伤风”(以下简称“降消”)项目对贵州省项目地区孕产妇死亡的影响。方法利用贵州省项目县历年上报孕产妇死亡数及死亡报告卡资料,描述分析“降消”项目实施前后孕产妇死亡模式的变化。结果 (1)“降消”实施以来,项目县住院分娩率由1999年的17.08%增加到2014年的98.48%,孕产妇死亡率由144.79/10万降低到29.44/10万。(2)产科出血、妊娠高血压综合征、羊水栓塞在整个项目期间一直是孕产妇死亡的主要原因,2010年住院分娩率提高到90%以上后,孕产妇死亡原因发生重要变化:产后出血、妊娠高血压综合征发病降低,肝静脉血栓形成和肺血栓居孕产妇前5位死亡原因;(3)产科出血死亡孕产妇死亡原因中,胎盘储留及宫缩乏力在整个项目周期中占产科出血病因构成比60%以上。2010年后因胎盘储留发生率下降,宫缩乏力超过胎盘储留成为引起产科出血死亡的主要原因。(4)2010-2014年住院分娩率97.56%,孕产妇总死亡率26.64/10万,家中分娩死亡率136.30/10万,住院分娩死亡率是14.69/10万。结论贵州省项目地区孕产妇死亡率从1999-2014年持续下降,产科出血和妊高征等可避免死因降低更明显。影响孕产妇死亡率的主要因素是住院分娩,因此应努力提高农村尤其是贵州省落后地区农村妇女的住院分娩率。
Objective To evaluate the impact of maternal mortality reduction and neonatal tetanus elimination on maternal mortality in the project area of Guizhou Province. Methods Using the information of maternal deaths and death report cards reported by the project counties in Guizhou Province, the change of maternal death patterns before and after the implementation of the “elimination cancellation” project was described and described. Results (1) Since the implementation of anti-dumping measures, the hospital delivery rate in project counties increased from 17.08% in 1999 to 98.48% in 2014, and the maternal mortality rate dropped from 144.79 / 100000 to 29.44 / 100000. (2) Obstetric bleeding, pregnancy-induced hypertension syndrome and amniotic fluid embolism have been the main causes of maternal deaths throughout the project. After the hospital delivery rate increased to more than 90% in 2010, the maternal mortality causes major changes: postpartum hemorrhage, The incidence of pregnancy-induced hypertension decreased, hepatic vein thrombosis and pulmonary thrombosis in the first five causes of maternal death; (3) obstetric hemorrhage causes of maternal deaths, placental retention and uterine inertia in the entire project cycle accounted for obstetrics Etiology constitute more than 60%. 2010 due to the decline in the incidence of placental retention, uterine inertia than placental retention has become the main cause of death from obstetric hemorrhage. (4) The hospital delivery rate was 97.56% in 2010-2014, the total maternal mortality rate was 26.64 / 100000, the death rate at home delivery was 136.30 / 100000 and the hospital delivery mortality rate was 14.69 / 100000. Conclusion The maternal mortality rate in the project area of Guizhou Province has been declining continuously from 1999 to 2014, and the cause of death can be avoided more obviously, such as obstetric bleeding and PIH. The main factor that affects the maternal mortality rate is hospital delivery. Therefore, efforts should be made to increase the hospital delivery rate of rural women in the rural areas, especially in the backward areas of Guizhou Province.