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  • 蒋美芳,施君瑶,董倩.上海市浦东新区2010—2019年1 408例产科危重孕产妇现况分析[J].同济大学学报(医学版),2021,42(5):672-677.    [点击复制]
  • JIANG Mei-fang,SHI Jun-yao,DONG Qian.Analysis of 1 408 cases of critically ill pregnant women in Pudong New Area of Shanghai from 2010 to 2019[J].同济大学学报(医学版),2021,42(5):672-677.   [点击复制]
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上海市浦东新区2010—2019年1 408例产科危重孕产妇现况分析
蒋美芳,施君瑶,董倩
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(上海市浦东新区妇幼保健所,上海201300;上海交通大学医学院附属仁济医院妇产科,上海200127)
摘要:
目的分析近十年上海市浦东新区产科危重孕产妇疾病谱特点和变化趋势,探讨如何预防产科危重孕产妇发生和提高对产科危重孕产妇救治能力。方法回顾性分析2010—2019年上海市浦东新区所有助产医疗机构上报的产科危重孕产妇病例1 408例临床资料。结果产科危重孕产妇发生率0.32%,病死率2.41%;患者平均年龄(29.9±5.5)岁;危重发生平均孕周34(28~37)周,直接产科原因危重发生孕周36(33~38)周,间接产科原因危重发生孕周为31(23~35)周;直接产科原因753例(53.5%),间接产科原因后5年(2015—2019年)占比56.1%,高于前5年(2010—2014年)的50.3%(χ2=4.605,P=0.032);10年间产科出血始终位居危重原因首位,此外,前3顺位主要以子痫前期/子痫、妊娠合并严重心血管疾病和妊娠合并血液病为主。前5年以子痫前期/子痫为第2顺位,后5年以妊娠合并心血管疾病为第2顺位;危重孕产妇死亡中间接产科原因占76.5%,妊娠合并心血管疾病占间接产科原因的50%。结论加强30岁孕产妇的妊娠预警评估,设立符合疾病谱的专病门诊;提前心、肝和肾功能全面复查孕周,做到早发现早诊断早转诊,减少严重并发症和甚至危重发生。
关键词:  产科  危重孕产妇  病因  保健
DOI:10.12289/j.issn.1008-0392.21191
投稿时间:2021-05-12
基金项目:上海市浦东新区卫生健康委员会面上项目(PW2019A-47)
Analysis of 1 408 cases of critically ill pregnant women in Pudong New Area of Shanghai from 2010 to 2019
JIANG Mei-fang,SHI Jun-yao,DONG Qian
(Shanghai Pudong New Area Maternal and Child Health Institute, Shanghai 201300, China;Dept. of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China)
Abstract:
ObjectiveTo analyze the characteristics and trends of the critical maternal disease spectrum in Pudong New Area of Shanghai during last ten years. MethodsA total of 1 408 cases of critically ill pregnant women reported by all midwifery institutions in Pudong New Area of Shanghai from 2010 to 2019 were retrospectively analyzed. ResultsThe incidence of critical maternal conditions was 0.32% and the case fatality rate was 2.41%. The mean age of the patients was(29.9±5.5) years. The mean gestational week for critical cases was 34(28-37) weeks; 36(33-38) weeks for direct obstetric causes and 31(23-35) weeks for indirect obstetric causes. The proportion of the direct causes in the second 5 years(2015-2019) was higher than that in the first 5 years(2010-2014)[56.1%(427/761) vs 50.3%(326/647), χ2=4.605, P=0.032]. During the 10 years, obstetric hemorrhage was the most common cause of critically ill pregnancy, followed by preeclampsia/eclampsia, pregnancy with severe cardiovascular diseases and pregnancy with hematologic diseases. In the first 5 years, preeclampsia/eclampsia ranked the second, while pregnancy combined with cardiovascular disease became the second order in the second 5 years. Pregnancy with cardiovascular disease accounted for 50% of indirect obstetric causes, and for 76.5% of the deaths of critically ill pregnancy. ConclusionIt is suggested that the early warning evaluation for high risk pregnant women should be strengthened and the comprehensive review of heart, liver and kidney functions should be carried out, in order to prevent serious pregnant complications and reduce maternal mortality.
Key words:  obstetrics  critical maternal  etiology  care

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