2011～2017年上海市浦东新区围产儿死亡情况分析
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摘要
目的通过对2011～2017年间浦东新区围产儿死亡情况进行研究,了解浦东新区围产儿死亡管理现状,从而针对性地提出干预措施,以期进一步降低当地围产儿死亡率。方法采用回顾性分析的方法,对浦东新区2011～2017年收集的全部围产儿死亡个案及死亡评审资料中的相关数据进行统计分析。结果 (1)2011～2017年浦东新区平均围产儿死亡率为3.91‰,其中本市户籍围产儿死亡率为2.78‰,非本市户籍围产儿死亡率为4.69‰;围产儿死亡率呈逐年下降趋势。(2)7年间浦东新区死胎率2.29‰、死产率0.15‰、早期新生儿死亡率1.47‰,均呈逐年下降趋势。(3)7年间在发生围产儿死亡的人群中,重点孕产妇的比例上升显著(P<0.05),多胎妊娠的比例逐年上升显著(P<0.05);多胎妊娠中发生围产儿死亡者,使用辅助生殖技术(ART)的孕妇比例呈波动性上升趋势;(4)7年间围产儿死亡前5位死因依次为:其它原因(18.6%)、早产儿(11.8%)、胎儿畸形(9.5%)、原因不明(8.3%)和脐带扭转(6.4%)。结论浦东新区围产儿死亡率较低,处于中等发达国家水平;为进一步提高浦东新区围产儿死亡管理水平,应加强流动孕产妇的孕期管理,防止死胎;探索新的围产儿死因分类方法和管理策略,重视健康教育及遗传咨询服务人员的培养。
Objective:To evaluate the current management status of perinatal death in Pudong New District of Shanghai from 2011 to 2017,in order to provide interventions accordingly for further reducing the local perinatal death rate.Methods:A retrospective analysis was conducted to statistically analyze the relevant data of perinatal death and death assessment collected in Pudong New District from 2011 to 2017.Results:In 2011-2017,the average perinatal mortality rate(PMR)in Pudong New District was 3.91‰.The PMR of people with Shanghai household registration was 2.78‰,and that of people without Shanghai household registration was 4.69‰.The perinatal mortality is decreasing year by year.The average rate of dead fetus was 2.29‰,the average rate of stillbirth was 0.15‰,and the average rate of early neonatal death was 1.47‰.All the rates showed a downward trend.The proportion of high-risk pregnancies in the perinatal death increased significantly(P<0.05),and the proportion of multiple pregnancies increased significantly year by year(P<0.05).The proportion of pregnant women with assisted reproductive technology(ART)was increasing in the perinatal death of multiple pregnancies.In the past 7 years,the top 5 causes of death in perinatal infants were as following:other causes(18.6%),premature infants(11.8%),fetal malformation(9.5%),unexplained causes(8.3%),and umbilical cord torsion(6.4%).Conclusions:The perinatal mortality in Pudong New District was low,which was at the level of moderately developed countries.In order to further improve the management level of perinatal death in this area,maternal management in the floating population should be strengthened and stillbirth should be prevented.The new classification methods and management strategies for perinatal causes of death should be explored,and the training of health education and genetic counseling services should be paid attention.
Objective:To evaluate the current management status of perinatal death in Pudong New District of Shanghai from 2011 to 2017,in order to provide interventions accordingly for further reducing the local perinatal death rate.Methods:A retrospective analysis was conducted to statistically analyze the relevant data of perinatal death and death assessment collected in Pudong New District from 2011 to 2017.Results:In 2011-2017,the average perinatal mortality rate(PMR)in Pudong New District was 3.91‰.The PMR of people with Shanghai household registration was 2.78‰,and that of people without Shanghai household registration was 4.69‰.The perinatal mortality is decreasing year by year.The average rate of dead fetus was 2.29‰,the average rate of stillbirth was 0.15‰,and the average rate of early neonatal death was 1.47‰.All the rates showed a downward trend.The proportion of high-risk pregnancies in the perinatal death increased significantly(P<0.05),and the proportion of multiple pregnancies increased significantly year by year(P<0.05).The proportion of pregnant women with assisted reproductive technology(ART)was increasing in the perinatal death of multiple pregnancies.In the past 7 years,the top 5 causes of death in perinatal infants were as following:other causes(18.6%),premature infants(11.8%),fetal malformation(9.5%),unexplained causes(8.3%),and umbilical cord torsion(6.4%).Conclusions:The perinatal mortality in Pudong New District was low,which was at the level of moderately developed countries.In order to further improve the management level of perinatal death in this area,maternal management in the floating population should be strengthened and stillbirth should be prevented.The new classification methods and management strategies for perinatal causes of death should be explored,and the training of health education and genetic counseling services should be paid attention.
引文
[1]朱丽萍,许厚琴,秦敏,等.2005~2008年上海市围产儿死亡情况分析[J].中国妇幼保健,2009,24:4844-4846.
[2]华嘉增,朱丽萍.现代妇女保健学[M].上海:复旦大学出版社,2011:95.
[3]Aquino MMA,Cecatti JG,et al.Risk factor associated to fetal death[J].Rev Paul Med,1998;116:2-7.
[4]上海市卫生局.上海市孕产妇保健工作规范[Z].2012-12-11.
[5]Wang H,Liddell CA,Coates MM,et al.Global,regional,and national levels of neonatal,infant and under-5 mortality during 1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet,2014,384:957-979.
[6]庄艳艳,刘彩霞.中国围产儿死亡率地区差异可能原因及产科处置对策[J].中国实用妇科与产科杂志,2015,31:1088-1090.
[7]杜莉,何丽芸,秦敏.1991至2015年上海市围产儿死亡情况分析[J].中国妇幼健康研究,2017,28:1041-1044.
[8]Aminu M,Unkels R,Mdegela M,et al.Causes of and factors associated with stillbirth in low-and middle-income countries:a systematic literature review[J].BJOG,2014,121(Suppl 4):141-153.
[9]Blencowe H,Cousens S,Jassir FB,et al.National,regional,and worldwide estimates of stillbirth rates in 2015,with trends from 2000:a systematic analysis[J].Lancet Glob Health,2016,4:e98-e108.
[10]陈敦金,贺芳.产科医师需关注死胎问题[J].中国实用妇科与产科杂志,2017,33:1105-1108.
[11]胡美娜,张颖,北京市海淀区围产儿死亡特征与干预措施探讨[J].中国妇幼健康研究,2017,28:29-31.
[12]曾红燕,刘保华,黎金钱,等.2006-2015年深圳市罗湖区围产儿死亡情况分析[J].中国妇幼卫生杂志,2016,7:11-14.
[13]Blickstein I,Perlman S.Single fetal death in twin gestations[J].J Perinat Med,2013,41:65-69.
[14]Silver RM,Varner MW,Reddy U,et al.Work-up of stillbirth:a review of the evidence[J].Am J Obstet Gynecol,2007,196:433-444.
[15]姚娟,郑洁,吴蔓,等.“全面二胎”政策实施后辅助生殖技术妇女的临床特征研究[J].中国妇幼保健,2018,33:4331-4333.
[16]姚雁,金龙妹,曹晶.上海市闵行区6年围产儿死亡分析及干预对策[J].医药前沿,2014,7:83-84.
[17]周莹,高劲松,胡静,等.围产儿死亡151例分析[J].生殖医学杂志,2018,27:299-304.
[2]华嘉增,朱丽萍.现代妇女保健学[M].上海:复旦大学出版社,2011:95.
[3]Aquino MMA,Cecatti JG,et al.Risk factor associated to fetal death[J].Rev Paul Med,1998;116:2-7.
[4]上海市卫生局.上海市孕产妇保健工作规范[Z].2012-12-11.
[5]Wang H,Liddell CA,Coates MM,et al.Global,regional,and national levels of neonatal,infant and under-5 mortality during 1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet,2014,384:957-979.
[6]庄艳艳,刘彩霞.中国围产儿死亡率地区差异可能原因及产科处置对策[J].中国实用妇科与产科杂志,2015,31:1088-1090.
[7]杜莉,何丽芸,秦敏.1991至2015年上海市围产儿死亡情况分析[J].中国妇幼健康研究,2017,28:1041-1044.
[8]Aminu M,Unkels R,Mdegela M,et al.Causes of and factors associated with stillbirth in low-and middle-income countries:a systematic literature review[J].BJOG,2014,121(Suppl 4):141-153.
[9]Blencowe H,Cousens S,Jassir FB,et al.National,regional,and worldwide estimates of stillbirth rates in 2015,with trends from 2000:a systematic analysis[J].Lancet Glob Health,2016,4:e98-e108.
[10]陈敦金,贺芳.产科医师需关注死胎问题[J].中国实用妇科与产科杂志,2017,33:1105-1108.
[11]胡美娜,张颖,北京市海淀区围产儿死亡特征与干预措施探讨[J].中国妇幼健康研究,2017,28:29-31.
[12]曾红燕,刘保华,黎金钱,等.2006-2015年深圳市罗湖区围产儿死亡情况分析[J].中国妇幼卫生杂志,2016,7:11-14.
[13]Blickstein I,Perlman S.Single fetal death in twin gestations[J].J Perinat Med,2013,41:65-69.
[14]Silver RM,Varner MW,Reddy U,et al.Work-up of stillbirth:a review of the evidence[J].Am J Obstet Gynecol,2007,196:433-444.
[15]姚娟,郑洁,吴蔓,等.“全面二胎”政策实施后辅助生殖技术妇女的临床特征研究[J].中国妇幼保健,2018,33:4331-4333.
[16]姚雁,金龙妹,曹晶.上海市闵行区6年围产儿死亡分析及干预对策[J].医药前沿,2014,7:83-84.
[17]周莹,高劲松,胡静,等.围产儿死亡151例分析[J].生殖医学杂志,2018,27:299-304.
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